Healthcare Provider Details

I. General information

NPI: 1629754585
Provider Name (Legal Business Name): EVELYN ISSAM FADEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S WASHINGTON AVE
SAGINAW MI
48601-2556
US

IV. Provider business mailing address

1000 HOUGHTON AVE
SAGINAW MI
48602-5303
US

V. Phone/Fax

Practice location:
  • Phone: 989-558-6425
  • Fax: 989-746-7723
Mailing address:
  • Phone: 989-558-6425
  • Fax: 989-746-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5151016097
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number5151016097
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: