Provider Demographics
NPI:1235723271
Name:HAIDAR AHMAD, HANI
Entity Type:Individual
Prefix:
First Name:HANI
Middle Name:
Last Name:HAIDAR AHMAD
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:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-0014
Mailing Address - Country:US
Mailing Address - Phone:313-722-4424
Mailing Address - Fax:313-722-4423
Practice Address - Street 1:5871 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1214
Practice Address - Country:US
Practice Address - Phone:313-722-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist