Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016005723 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 65 P88839 | NY |
NPI | 1013300839 |
---|---|
Provider Name | Dr. Fahed Nazem Elchami |
First Address | Peoria, IL 61614-3294 |
Second Address | Peoria, IL 61614-3294 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2015 |
Last Update Date | 31/12/2019 |