Healthcare Provider Details

I. General information

NPI: 1699761056
Provider Name (Legal Business Name): FADI YOSEF MALEK M.D. F.C.C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FADI YUSSEF MALEK M.D. F.C.C.P.

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 BENDEL RD
LAFAYETTE LA
70503-2903
US

IV. Provider business mailing address

227 BENDEL RD
LAFAYETTE LA
70503-2903
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-5864
  • Fax: 337-234-6887
Mailing address:
  • Phone: 337-232-5864
  • Fax: 337-234-6887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number11796R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: