Provider Demographics
NPI:1063676286
Name:HAOUILOU, JIMMY CHARBEL (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:CHARBEL
Last Name:HAOUILOU
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 1:29519 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1275
Mailing Address - Country:US
Mailing Address - Phone:586-270-5100
Mailing Address - Fax:586-270-5111
Practice Address - Street 1:29519 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:586-270-5100
Practice Address - Fax:586-270-5111
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084691208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery