Healthcare Provider Details

I. General information

NPI: 1467672485
Provider Name (Legal Business Name): FADI ALHATEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ROBERTSON BLVD STE 505
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

PO BOX 54679
LOS ANGELES CA
90054-0679
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-3530
  • Fax: 310-385-3322
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberD77403
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberD77403
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberC159408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: