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NPI Code Detail

MEDICARE: FADEL SAKKAL MD

MEDICARE: FADEL SAKKAL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician31414MN

General Provider Information

NPI Number : 1619938396
Entity Type Code : Individual
Provider Name (Legal Business Name) : FADEL SAKKAL MD
Provider Business Mailing Address
First Line : 11107 ULYSSES ST NE STE 100
Second Line :
City : BLAINE
State : MN
Zip : 55434-4264
Country : US
Telephone Number : 763-333-7723
Fax Number : 763-333-7711
Provider Business Practice Location Address
First Line : 11107 ULYSSES ST NE STE 100
Second Line :
City : BLAINE
State : MN
Zip : 55434-4264
Country : US
Telephone Number : 763-333-7723
Fax Number : 763-333-7711
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2006
Last Update Date : 06/30/2021

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