Provider Demographics
NPI:1346644556
Name:HADDAD, ATHRAA
Entity Type:Individual
Prefix:MRS
First Name:ATHRAA
Middle Name:
Last Name:HADDAD
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 1:36843 KYRO CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4600
Mailing Address - Country:US
Mailing Address - Phone:586-601-6434
Mailing Address - Fax:
Practice Address - Street 1:36843 KYRO CT
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4600
Practice Address - Country:US
Practice Address - Phone:586-601-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker