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General NPI Number Information
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NPI Number | 1750313250
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF BLOOMINGTON, PC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 822 W 1ST ST SUITE 8
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2384
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Country | US
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Telephone | 812-336-4707
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Fax | 812-334-1093
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Provider Business Mailing Address
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Address Line | 822 W 1ST ST SUITE 8
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2384
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Country | US
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Telephone | 812-336-4707
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Fax | 812-334-1093
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Authorized Official
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Title or Position | OWNER
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Name | FADI HADDAD
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Credential | MD
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Telephone | 812-336-4707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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