Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | OS16977 | FL |
NPI | 1285163642 |
---|---|
Provider Name | Abrahim Ali Fahs |
First Address | Hinsdale, IL 60521-3860 |
Second Address | Riverview, FL 33569-5631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2017 |
Last Update Date | 01/11/2021 |