Provider Demographics
NPI:1083826473
Name:HAMAD, HAMAD IBRAHIM (DPT)
Entity Type:Individual
Prefix:
First Name:HAMAD
Middle Name:IBRAHIM
Last Name:HAMAD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27112 WINSLOW AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3999
Mailing Address - Country:US
Mailing Address - Phone:248-376-5834
Mailing Address - Fax:586-751-1222
Practice Address - Street 1:21331 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3265
Practice Address - Country:US
Practice Address - Phone:248-376-5834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650F301970OtherPHYSICAL THERAPY
MIN84310003Medicare ID - Type UnspecifiedPHYSICAL THERAPY
MI0P30080Medicare ID - Type UnspecifiedPHYSICAL THERAPY