Provider Demographics
NPI:1821022708
Name:BASHOUR, FADI N (MD)
Entity type:Individual
Prefix:DR
First Name:FADI
Middle Name:N
Last Name:BASHOUR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE GI CREDENTIALING DEPARTMENT
Mailing Address - Street 2:PO BOX 381468
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183
Mailing Address - Country:US
Mailing Address - Phone:330-225-6468
Mailing Address - Fax:330-225-6534
Practice Address - Street 1:3985 MEDINA RD STE 120
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5968
Practice Address - Country:US
Practice Address - Phone:330-225-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065615207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551831Medicaid
OH9275411Medicare PIN
OHG32495Medicare UPIN