Provider Demographics
NPI:1891850921
Name:FATTEH, NAAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:NAAZ
Middle Name:
Last Name:FATTEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-712-6427
Mailing Address - Fax:954-712-6475
Practice Address - Street 1:1625 SE 3RD AVE STE 623
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:954-712-6427
Practice Address - Fax:954-712-6475
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052723207R00000X
MDD56436207R00000X
DCMD32455207RI0200X
FLME65183207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002227500Medicaid
G59712Medicare UPIN
FL002227500Medicaid