Provider Demographics
NPI:1417995507
Name:BEYDOUN, INSHAD HASSAN (PA)
Entity Type:Individual
Prefix:
First Name:INSHAD
Middle Name:HASSAN
Last Name:BEYDOUN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4789 WESTLAND ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2809
Mailing Address - Country:US
Mailing Address - Phone:313-582-0217
Mailing Address - Fax:
Practice Address - Street 1:4789 WESTLAND ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2809
Practice Address - Country:US
Practice Address - Phone:313-582-0217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003140363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P34350001Medicare PIN