Provider Demographics
NPI:1093788069
Name:HADDAD, SHAKER HANNA (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAKER
Middle Name:HANNA
Last Name:HADDAD
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 1:12813 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1532
Mailing Address - Country:US
Mailing Address - Phone:313-581-8090
Mailing Address - Fax:
Practice Address - Street 1:12813 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1532
Practice Address - Country:US
Practice Address - Phone:313-581-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048228208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301048228OtherCONTROLLED SUBSTANCE LIC.
MI1093788069Medicaid
MI4301048228OtherPHYSICIAN LICENSE
MIA76546Medicare UPIN