# FIDAMAR MEDICAL LLP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497511588
- **Authorized official:** FAIDHERBE CEUS (OWNER)
- **Authorized official phone:** (845) 623-3120

## Contact information

- **Practice address:** 451 W MILHAM AVE, PORTAGE, MI 49024-2721
- **Practice address phone:** (269) 254-8400
- **Practice address fax:** (269) 254-8350
- **Mailing address:** 451 W MILHAM AVE, PORTAGE, MI 49024-2721

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 02/26/2024
- **Last updated:** 02/26/2024