Healthcare Provider Details

I. General information

NPI: 1124236690
Provider Name (Legal Business Name): FADI HAWAWINI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 HOUMA BLVD STE 300
METAIRIE LA
70006-4203
US

IV. Provider business mailing address

3530 HOUMA BLVD STE 300
METAIRIE LA
70006-4203
US

V. Phone/Fax

Practice location:
  • Phone: 504-264-5142
  • Fax: 504-455-2648
Mailing address:
  • Phone: 504-264-5142
  • Fax: 504-455-2648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO000042
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO.000042
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: