Provider Demographics
NPI:1093607244
Name:AL-FADHL, MAHMOUD
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:AL-FADHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52103 BRENDON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7811
Mailing Address - Country:US
Mailing Address - Phone:574-485-8828
Mailing Address - Fax:
Practice Address - Street 1:52103 BRENDON HILLS DR
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-7811
Practice Address - Country:US
Practice Address - Phone:574-485-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program