Provider Demographics
NPI:1447224043
Name:HADDAD, JIRIES T (MD)
Entity Type:Individual
Prefix:DR
First Name:JIRIES
Middle Name:T
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 DIX
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1566
Mailing Address - Country:US
Mailing Address - Phone:313-841-1680
Mailing Address - Fax:313-841-3123
Practice Address - Street 1:9720 DIX
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1566
Practice Address - Country:US
Practice Address - Phone:313-841-1680
Practice Address - Fax:313-841-3123
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJH047038208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1737335Medicaid
B44496Medicare UPIN