Provider Demographics
NPI:1952577231
Name:AKOUM, FADI HUSAYN (MD)
Entity type:Individual
Prefix:DR
First Name:FADI
Middle Name:HUSAYN
Last Name:AKOUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:550-627-2983
Practice Address - Street 1:1100 GOETHALS DRIVE FIRST FLOOR
Practice Address - Street 2:KADLEC NEUROSCIENCE CENTER
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-943-5580
Practice Address - Fax:509-943-5922
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00049224207RN0300X
ORMD28176207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0258389OtherLABOR & INDUSTRIES
OR0280437OtherSAIF
WA8531360Medicaid
WA2006941Medicaid
OR026200Medicaid
WA8531360Medicaid
WA8897557Medicare PIN