Provider Demographics
NPI:1760936652
Name:ZEITOUN, FAHED (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:FAHED
Middle Name:
Last Name:ZEITOUN
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 W PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-7020
Mailing Address - Country:US
Mailing Address - Phone:630-504-9136
Mailing Address - Fax:
Practice Address - Street 1:1526 W PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-7020
Practice Address - Country:US
Practice Address - Phone:630-504-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16-393246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant