Healthcare Provider Details

I. General information

NPI: 1962011833
Provider Name (Legal Business Name): FARES SUKHON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 E RUSHOLME ST STE 300
DAVENPORT IA
52803-2484
US

IV. Provider business mailing address

1236 E RUSHOLME ST STE 300
DAVENPORT IA
52803-2484
US

V. Phone/Fax

Practice location:
  • Phone: 563-324-2992
  • Fax: 563-324-8562
Mailing address:
  • Phone: 563-324-2992
  • Fax: 563-324-8562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD-55482
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD-55482
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: