Basic Information
| Provider Information | |||||||||
| NPI: | 1336246230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAIDI | ||||||||
| FirstName: | ABDUL | ||||||||
| MiddleName: | FATTAH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2709 HEMLOCK ST | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983102623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607826000 | ||||||||
| FaxNumber: | 2538355511 | ||||||||
| Practice Location | |||||||||
| Address1: | 2709 HEMLOCK ST | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983102623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607826000 | ||||||||
| FaxNumber: | 2538355511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 6223254-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0011X | MD60862283 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 1336246230 | 05 | UT | MEDICAID | 2111622 | 05 | WA | MEDICAID |