Healthcare Provider Details

I. General information

NPI: 1962226886
Provider Name (Legal Business Name): PATRICK I FAKHOURY BS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

2565 TRILLIUM HILLS DR
COMMERCE TOWNSHIP MI
48382-2196
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8487
  • Fax:
Mailing address:
  • Phone: 248-460-3308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number545645646
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: