Provider Demographics
NPI:1720247737
Name:FAKHOURI, TAREK (MD, MS)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:
Last Name:FAKHOURI
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17510 W GRAND PKWY S STE 420
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2173
Mailing Address - Country:US
Mailing Address - Phone:832-308-3470
Mailing Address - Fax:832-308-3471
Practice Address - Street 1:17510 W GRAND PKWY S STE 420
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2173
Practice Address - Country:US
Practice Address - Phone:832-308-3470
Practice Address - Fax:832-308-3471
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092701207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX369195YLUVMedicare PIN
TX369195YME1Medicare PIN
510G700457Medicare PIN
TX369195YLUXMedicare PIN