Provider Demographics
NPI:1295391035
Name:ALHARASH, REDWAN
Entity Type:Individual
Prefix:
First Name:REDWAN
Middle Name:
Last Name:ALHARASH
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 1:14263 BARCLAY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3573
Mailing Address - Country:US
Mailing Address - Phone:313-899-8280
Mailing Address - Fax:
Practice Address - Street 1:3 PARKLANE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2506
Practice Address - Country:US
Practice Address - Phone:313-899-8280
Practice Address - Fax:313-799-0353
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health