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General NPI Number Information
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NPI Number | 1821022708
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Entity Type | Individual
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Provider Name | FADI N. BASHOUR MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 3985 MEDINA RD STE 120
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City | MEDINA
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State | OH
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Zip | 44256-5968
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Country | US
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Telephone | 330-225-6468
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Fax |
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Provider Business Mailing Address
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Address Line | ONE GI CREDENTIALING DEPARTMENT PO BOX 381468
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City | GERMANTOWN
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State | TN
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Zip | 38183
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Country | US
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Telephone | 330-225-6468
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Fax | 330-225-6534
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 35065615
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License Number State | OH
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