Provider Demographics
NPI:1346265816
Name:HADDAD, LORI A (DO)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:HADDAD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7260
Mailing Address - Country:US
Mailing Address - Phone:248-645-0830
Mailing Address - Fax:248-645-2863
Practice Address - Street 1:2151 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7260
Practice Address - Country:US
Practice Address - Phone:248-645-0830
Practice Address - Fax:248-645-2863
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILH0105084207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0756304784OtherBCBSM PROVIDER I.D.
MI5250147Medicare ID - Type UnspecifiedMEDICARE PROVIDER I.D.
MI0756304784OtherBCBSM PROVIDER I.D.