Provider Demographics
NPI:1275265126
Name:BAYDOUN, HANADI
Entity Type:Individual
Prefix:
First Name:HANADI
Middle Name:
Last Name:BAYDOUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5557 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3615
Mailing Address - Country:US
Mailing Address - Phone:313-577-4082
Mailing Address - Fax:
Practice Address - Street 1:851 DREXEL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1606
Practice Address - Country:US
Practice Address - Phone:313-455-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2023-12-05
Deactivation Date:2023-11-10
Deactivation Code:
Reactivation Date:2023-11-22
Provider Licenses
StateLicense IDTaxonomies
MI4704348699163WC0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine