Healthcare Provider Details

I. General information

NPI: 1528028412
Provider Name (Legal Business Name): FADI A SAAB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E BELTLINE AVE NE STE 101
GRAND RAPIDS MI
49525-4598
US

IV. Provider business mailing address

1525 E BELTLINE AVE NE STE 101
GRAND RAPIDS MI
49525-4598
US

V. Phone/Fax

Practice location:
  • Phone: 616-447-8220
  • Fax:
Mailing address:
  • Phone: 616-447-8220
  • Fax: 616-252-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number231026
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301078144
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: