Provider Demographics
NPI:1487903910
Name:AL DAOUD, FADI KHALIL (MD)
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:KHALIL
Last Name:AL DAOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4160 JOHN R ST
Mailing Address - Street 2:SUITE 930
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2020
Mailing Address - Country:US
Mailing Address - Phone:313-966-5007
Mailing Address - Fax:313-966-0368
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:SUITE 930
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-966-5007
Practice Address - Fax:313-966-0368
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301099686207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery