Provider Demographics
NPI:1811203615
Name:HAMIDEH, FAYAD (MD)
Entity Type:Individual
Prefix:
First Name:FAYAD
Middle Name:
Last Name:HAMIDEH
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:BLUEWATER HEALTH
Mailing Address - Street 2:89 NORMAN STREET
Mailing Address - City:SARNIA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N7T 6S3
Mailing Address - Country:CA
Mailing Address - Phone:226-776-3306
Mailing Address - Fax:801-365-5170
Practice Address - Street 1:BLUEWATER HEALTH
Practice Address - Street 2:89 NORMAN STREET
Practice Address - City:SARNIA
Practice Address - State:ONTARIO
Practice Address - Zip Code:N7T 6S3
Practice Address - Country:CA
Practice Address - Phone:226-776-3306
Practice Address - Fax:801-365-5170
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA056254207R00000X
MI4301095301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine