Provider Demographics
NPI:1992226518
Name:AL HALBAN, FAHAD ADEL (MD)
Entity type:Individual
Prefix:MR
First Name:FAHAD
Middle Name:ADEL
Last Name:AL HALBAN
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 1:2475 BRICKELL AVENUE
Mailing Address - Street 2:2501, THE METROPOLITAN
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129
Mailing Address - Country:US
Mailing Address - Phone:786-498-3949
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:JACKSON MEMORIAL HOSPITAL
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-585-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2018-02-21
Deactivation Date:2018-02-08
Deactivation Code:
Reactivation Date:2018-02-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program