MEDICARE: DR. FATHALLAH HAYEK 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
1	207P00000X	Emergency Medicine Physician	35-053400	OH
2	207Q00000X	Family Medicine Physician	35-053400	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	H059041	OTHER	OH	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	264200002	OTHER	OH	FEDERAL BLACK LUNG
2	000000339404	OTHER	OH	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	264200002	OTHER	OH	DEPT OF LABOR
6	341425870040	OTHER	OH	MEDICAL MUTUAL OF OHIO
7	6600162	OTHER	OH	UNITED HEALTHCARE
8	80507	OTHER	OH	QUALCHOICE

General Provider Information

NPI Number	:	1689634727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FATHALLAH HAYEK MD

Provider Business Mailing Address
First Line	:	36000 EUCLID AVE # MSO
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4625
Country	:	US
Telephone Number	:	440-953-6082
Fax Number	:	440-953-6101

Provider Business Practice Location Address
First Line	:	6270 N RIDGE RD
Second Line	:
City	:	MADISON
State	:	OH
Zip	:	44057-2567
Country	:	US
Telephone Number	:	440-428-6800
Fax Number	:	440-255-3637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	05/06/2021

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Directions to “ DR. FATHALLAH HAYEK MD” Practice Location

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