Healthcare Provider Details

I. General information

NPI: 1356504831
Provider Name (Legal Business Name): FADI RAYMOND MAKHOUL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2008
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST DEPARTMENT OF SURGERY
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

3200 VINE ST
CINCINNATI OH
45220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 513-487-6626
  • Fax:
Mailing address:
  • Phone: 859-539-3035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number44637
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number44637
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number44637
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: