Individual
DR. FADI G GHANEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1111 MEDICAL PLAZA DR, SUITE 230, THE WOODLANDS, TX 77380-3477
(281) 419-1599
(281) 898-7632
Mailing address
PO BOX 7727, THE WOODLANDS, TX 77380-7727
(281) 419-1599
(281) 898-7632
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H8071
TX
208D00000X
General Practice Physician
H8071
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139600406
—
TX
01
—
139600417
EPSDT
TX
01
—
83900X
BCBS OF TX
TX
Enumeration date
09/16/2005
Last updated
12/30/2014
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