Provider Demographics
NPI:1093330599
Name:HAIDAR, TAREK (MD)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:
Last Name:HAIDAR
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 1:2814 E PIKE STREET
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122
Mailing Address - Country:US
Mailing Address - Phone:913-498-6537
Mailing Address - Fax:913-498-6708
Practice Address - Street 1:5300 TALLMAN AVENUE NW., S SOUTH
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107
Practice Address - Country:US
Practice Address - Phone:206-781-6209
Practice Address - Fax:816-276-7090
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61404020207Q00000X, 207QA0401X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program