Provider Demographics
NPI:1023381290
Name:ZAID HANOUDI, M.D., PLLC
Entity Type:Organization
Organization Name:ZAID HANOUDI, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAID
Authorized Official - Middle Name:
Authorized Official - Last Name:HANOUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:248-953-6133
Mailing Address - Street 1:1261 S LAPEER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1419
Mailing Address - Country:US
Mailing Address - Phone:248-693-8634
Mailing Address - Fax:
Practice Address - Street 1:1261 S LAPEER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1419
Practice Address - Country:US
Practice Address - Phone:248-693-8634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM0217039Medicare PIN