Provider Demographics
NPI:1750311635
Name:FAYAD, FAHED (MD)
Entity Type:Individual
Prefix:
First Name:FAHED
Middle Name:
Last Name:FAYAD
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 1:5601 COLLINS AVE APT 612
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2444
Mailing Address - Country:US
Mailing Address - Phone:305-582-2068
Mailing Address - Fax:305-675-0662
Practice Address - Street 1:1400 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-325-5511
Practice Address - Fax:305-325-4451
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME558542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14857OtherBCBS
FL370758000Medicaid
FL14857Medicare ID - Type Unspecified
FL370758000Medicaid