Basic Information
Provider Information
NPI: 1871024562
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAWA
FirstName: FADI
MiddleName: NATHER SAID
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 24 FRANK LLOYD WRIGHT DR LBBY J2000
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481059484
CountryCode: US
TelephoneNumber: 7347476766
FaxNumber:  
Practice Location
Address1: 5333 MCAULEY DR
Address2: SUITE 4001
City: YPSILANTI
State: MI
PostalCode: 481971014
CountryCode: US
TelephoneNumber: 7347123980
FaxNumber: 7347123782
Other Information
ProviderEnumerationDate: 03/23/2017
LastUpdateDate: 08/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X4301502739MIY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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