Healthcare Provider Details

I. General information

NPI: 1205836608
Provider Name (Legal Business Name): FARIS FADHEEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 PROFESSIONAL BLVD STE 201
EVANSVILLE IN
47714-8019
US

IV. Provider business mailing address

1312 PROFESSIONAL BLVD STE 201
EVANSVILLE IN
47714-8019
US

V. Phone/Fax

Practice location:
  • Phone: 812-476-7523
  • Fax: 812-476-6686
Mailing address:
  • Phone: 812-476-7523
  • Fax: 812-476-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036101230
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301065910
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01052686A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: