Provider Demographics
NPI:1518529320
Name:FAHAD, ISMAIL MOHAMMED (MBBS)
Entity type:Individual
Prefix:DR
First Name:ISMAIL
Middle Name:MOHAMMED
Last Name:FAHAD
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31001-4114
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-4114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:402-559-9213
Practice Address - Street 1:105 W 8TH AVE STE 122C
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:402-559-5804
Practice Address - Fax:402-559-9213
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE86322084N0400X
WAMD616172882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology