Provider Demographics
NPI:1356383889
Name:BDAIR, FADI MOHAMMED THAER (MD)
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:MOHAMMED THAER
Last Name:BDAIR
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 1:802 N RIVERSIDE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2509
Mailing Address - Country:US
Mailing Address - Phone:816-271-7074
Mailing Address - Fax:816-385-8083
Practice Address - Street 1:802 N RIVERSIDE RD STE 220
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2509
Practice Address - Country:US
Practice Address - Phone:816-271-7074
Practice Address - Fax:816-385-8083
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012012460207RG0100X
KS0436448207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02702954Medicaid
KS30003987720003Medicaid
NY02702954Medicaid
NY172235BJOtherPREFERRED CARE
7585751OtherAETNA
NY2589596OtherGROUP HEALTH INCORPORATED
NYL02426-5W CIMOtherWORKER'S COMPENSATION
NYP020002426OtherBLUE SHIELD
7585751OtherAETNA
NY2589596OtherGROUP HEALTH INCORPORATED