Healthcare Provider Details

I. General information

NPI: 1164554572
Provider Name (Legal Business Name): FADI DAHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 UNION AVE STE 100
MEMPHIS TN
38104-4391
US

IV. Provider business mailing address

176 S BELLEVUE BLVD SUITE 502
MEMPHIS TN
38104-3417
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-1161
  • Fax: 901-726-0161
Mailing address:
  • Phone: 901-726-1199
  • Fax: 901-726-0794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD41879
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: