Basic Information
| Provider Information | |||||||||
| NPI: | 1235424656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAHDALEH | ||||||||
| FirstName: | FADI | ||||||||
| MiddleName: | SUHAIL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 HARVESTER DRIVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BURR RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737021150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5841 S. MARYLAND AVENUE | ||||||||
| Address2: | M/C 6040 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737026337 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2011 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | 036140272 | IL | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.