Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 036140272 | IL |
NPI | 1235424656 |
---|---|
Provider Name | Dr. Fadi Suhail Dahdaleh |
First Address | Burr Ridge, IL 60527 |
Second Address | Chicago, IL 60637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 24/03/2021 |