Provider Demographics
NPI:1710965298
Name:FATTEH, FAIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:FAIZ
Middle Name:
Last Name:FATTEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1551 SAWGRASS CORPORATE PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2828
Mailing Address - Country:US
Mailing Address - Phone:954-835-0750
Mailing Address - Fax:954-835-0760
Practice Address - Street 1:817 S UNIVERSITY DR
Practice Address - Street 2:STE 106
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3345
Practice Address - Country:US
Practice Address - Phone:954-723-0334
Practice Address - Fax:954-206-0064
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2017-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME70598207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250289500Medicaid
FLG21615Medicare UPIN
FL250289500Medicaid