Provider Demographics
NPI:1144293960
Name:GHISHAN, FAYEZ K (MD)
Entity type:Individual
Prefix:MR
First Name:FAYEZ
Middle Name:K
Last Name:GHISHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-7214
Mailing Address - Country:US
Mailing Address - Phone:520-626-4140
Mailing Address - Fax:520-626-4141
Practice Address - Street 1:535 N WILMOT RD
Practice Address - Street 2:SUITE #101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-694-9988
Practice Address - Fax:520-694-9917
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2013-05-29
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Provider Licenses
StateLicense IDTaxonomies
AZ233882080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZB53345Medicare UPIN