Healthcare Provider Details

I. General information

NPI: 1720297443
Provider Name (Legal Business Name): FADI ALQAISI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GOETHALS DRIVE KADLEC INLAND CARDIOLOGY
RICHLAND WA
99352
US

IV. Provider business mailing address

1100 GOETHALS DR
RICHLAND WA
99352-3300
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-2699
  • Fax: 509-946-2675
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-627-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301081955
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60218217
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD60218217
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: