Provider Demographics
NPI:1912955584
Name:LAYOUS, FADI (MD)
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:LAYOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 45TH AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2911
Mailing Address - Country:US
Mailing Address - Phone:219-934-2461
Mailing Address - Fax:219-934-2478
Practice Address - Street 1:761 45TH AVE
Practice Address - Street 2:STE 108
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2893
Practice Address - Country:US
Practice Address - Phone:219-922-5416
Practice Address - Fax:219-922-3745
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01058949207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200525520AMedicaid
IN200525520AMedicaid
IN499500 RRRMedicare PIN