Individual
FADI I ALZEIDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7863 BROADWAY, MERRILLVILLE, IN 46410-5553
(219) 769-6639
(219) 769-0636
Mailing address
55 E 86TH AVE, PO BOX 10645, MERRILLVILLE, IN 46410-6382
(219) 769-1670
(219) 738-6714
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01053003
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200300510
—
IN
Enumeration date
09/09/2005
Last updated
11/17/2020
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