Provider Demographics
NPI:1861582504
Name:SHAMIEH, FAYEZ KHADER (MD)
Entity type:Individual
Prefix:DR
First Name:FAYEZ
Middle Name:KHADER
Last Name:SHAMIEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S RYAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5728
Mailing Address - Country:US
Mailing Address - Phone:337-433-0762
Mailing Address - Fax:337-433-4868
Practice Address - Street 1:707 S RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5728
Practice Address - Country:US
Practice Address - Phone:337-433-0762
Practice Address - Fax:337-433-4868
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA150002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1191442Medicaid
LA5K487C529Medicare ID - Type Unspecified
LA1191442Medicaid