Provider Demographics
NPI:1164044129
Name:ALDAHAN, MOHAMMED HAIDER
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:HAIDER
Last Name:ALDAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N KEENE ST APT 73
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6600
Mailing Address - Country:US
Mailing Address - Phone:402-419-9576
Mailing Address - Fax:
Practice Address - Street 1:13013 FULLER AVE STE A
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2687
Practice Address - Country:US
Practice Address - Phone:816-214-5548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019046478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine