Provider Demographics
NPI:1740235183
Name:AL-FADHL, DAHAN HUSSEIN (MD)
Entity Type:Individual
Prefix:
First Name:DAHAN
Middle Name:HUSSEIN
Last Name:AL-FADHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E CEDAR ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2057
Mailing Address - Country:US
Mailing Address - Phone:574-335-8700
Mailing Address - Fax:574-335-0760
Practice Address - Street 1:611 E DOUGLAS
Practice Address - Street 2:SUITE 309
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1467
Practice Address - Country:US
Practice Address - Phone:574-335-6232
Practice Address - Fax:574-335-6233
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200300400AMedicaid
IN000000568251OtherBCBS
IN000000710327OtherBCBS-HOSPITALIST
IN000000568251OtherBCBS
IN200300400AMedicaid
INM400046277Medicare PIN
IN187760CMedicare PIN
IN110234013Medicare PIN