Basic Information
| Provider Information | |||||||||
| NPI: | 1386664597 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FADL | ||||||||
| FirstName: | HYTHAM | ||||||||
| MiddleName: | HASSAN MOHAMED | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HURLEY PLZ | ||||||||
| Address2: | SON, 5TH FLOOR | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485035902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102629353 | ||||||||
| FaxNumber: | 8102627308 | ||||||||
| Practice Location | |||||||||
| Address1: | 806 TUURI PL | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485032465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102579773 | ||||||||
| FaxNumber: | 8102627308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 02/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301082160 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.