Provider Demographics
NPI:1922039684
Name:NAMMOUR, FADEL E (MD)
Entity Type:Individual
Prefix:
First Name:FADEL
Middle Name:E
Last Name:NAMMOUR
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 1:5049 33RD AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104
Mailing Address - Country:US
Mailing Address - Phone:701-356-1001
Mailing Address - Fax:701-639-4550
Practice Address - Street 1:5049 33RD AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7080
Practice Address - Country:US
Practice Address - Phone:701-356-1001
Practice Address - Fax:701-639-4550
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45369207RG0100X
ND9025207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11936Medicaid
ND142762OtherUCARE #
NDDA9011031159OtherPREFERRED ONE #
ND030521900Medicaid
ND2900240OtherMEDICA #
MN2900367OtherMEDICA #
NDHP38398OtherHEALTHPARTNERS #
NDND200238OtherLHS #
ND1635118OtherAMERICA'S PPO/ARAZ #
MN25167OtherMNBS #
ND2900241OtherMEDICA #
ND22142OtherNDBS #
ND60G84NAOtherMNBS #
MN933S9NAOtherMNBS #
MN2900367OtherMEDICA #
ND142762OtherUCARE #
ND2900241OtherMEDICA #
MN933S9NAOtherMNBS #
ND22142OtherNDBS #