Provider Demographics
NPI:1093399487
Name:SWEIDAN, HISHAM BUTROS (MD)
Entity Type:Individual
Prefix:
First Name:HISHAM
Middle Name:BUTROS
Last Name:SWEIDAN
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 1:3470 DIUBLE RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9604
Mailing Address - Country:US
Mailing Address - Phone:661-438-5085
Mailing Address - Fax:
Practice Address - Street 1:6071 W. OUTER DRIVE
Practice Address - Street 2:48235
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:661-438-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program