Provider Demographics
NPI:1770010050
Name:FAZAL, ABID AMIRALI (MD)
Entity Type:Individual
Prefix:
First Name:ABID
Middle Name:AMIRALI
Last Name:FAZAL
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 1:300 PASTEUR DRIVE #H3580
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5640
Mailing Address - Country:US
Mailing Address - Phone:650-723-6412
Mailing Address - Fax:650-725-8544
Practice Address - Street 1:300 PASTEUR DRIVE #H3580
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5640
Practice Address - Country:US
Practice Address - Phone:650-723-6412
Practice Address - Fax:650-725-8544
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125070131207L00000X
CAA171411207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology