Healthcare Provider Details

I. General information

NPI: 1568466019
Provider Name (Legal Business Name): ABDULLAH A FAYYAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W3985 COUNTY ROAD NN
ELKHORN WI
53121-4337
US

IV. Provider business mailing address

W3985 COUNTY ROAD NN
ELKHORN WI
53121-4337
US

V. Phone/Fax

Practice location:
  • Phone: 262-741-2000
  • Fax:
Mailing address:
  • Phone: 262-741-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35432
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: