Provider Demographics
NPI:1124236690
Name:HAWAWINI, FADI (DO)
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:HAWAWINI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 HOUMA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4203
Mailing Address - Country:US
Mailing Address - Phone:504-264-5142
Mailing Address - Fax:504-455-2648
Practice Address - Street 1:3530 HOUMA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4203
Practice Address - Country:US
Practice Address - Phone:504-264-5142
Practice Address - Fax:504-455-2648
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADO000042207R00000X
LADO.000042208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1067369Medicaid
MS02888369Medicaid
LA4K513Medicare PIN