Provider Demographics
NPI:1912973785
Name:JAMOUS, FADY GHASSAN (MD)
Entity Type:Individual
Prefix:
First Name:FADY
Middle Name:GHASSAN
Last Name:JAMOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1301 S. CLIFF AVE.
Practice Address - Street 2:STE. 601
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1032
Practice Address - Country:US
Practice Address - Phone:605-322-6930
Practice Address - Fax:605-322-6931
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD5716207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2385644OtherARAZ/ AMERICA'S PPO
SD4800456OtherMEDICA
SDHP56608OtherHEALTHPARTNERS
SD247965OtherMIDLANDS CHOICE
SD407141045262OtherPREFERRED ONE
MN92411422905OtherPRIMEWEST
SDP00303619OtherRR MEDICARE
SD5716OtherDAKOTACARE
MN80G66JAOtherCC SYSTEMS/ BLUE PLUS
IA0598441Medicaid
NE46022474347Medicaid
IL2177820538Medicaid
SD6005230Medicaid
MN80G66JAOtherBLUE CROSS
MN353995400Medicaid
SD4994409OtherBLUE CROSS
SD57105W009OtherWPS TRICARE
NE46022474347Medicaid
IA0598441Medicaid