Provider Demographics
NPI:1356427959
Name:FADI ABOU-ISSA, MD A MEDICAL LLC
Entity type:Organization
Organization Name:FADI ABOU-ISSA, MD A MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOU-ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-851-6653
Mailing Address - Street 1:8120 MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3403
Mailing Address - Country:US
Mailing Address - Phone:985-851-6653
Mailing Address - Fax:
Practice Address - Street 1:8120 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3403
Practice Address - Country:US
Practice Address - Phone:985-851-6653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11737R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4A639Medicare ID - Type Unspecified