Healthcare Provider Details

I. General information

NPI: 1922702489
Provider Name (Legal Business Name): FADY FAWZY NAGUIB MIKHAEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7817 W KIMBERLY WAY
GLENDALE AZ
85308-6118
US

IV. Provider business mailing address

7817 W KIMBERLY WAY
GLENDALE AZ
85308-6118
US

V. Phone/Fax

Practice location:
  • Phone: 480-450-1640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA206721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: