Provider Demographics
NPI:1508880063
Name:HADDAD, IMAD (MD)
Entity Type:Individual
Prefix:
First Name:IMAD
Middle Name:
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 1:805 BARDSTOWN RD STE 12
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-1515
Mailing Address - Country:US
Mailing Address - Phone:859-481-7113
Mailing Address - Fax:859-481-7114
Practice Address - Street 1:805 BARDSTOWN RD STE 12
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-1515
Practice Address - Country:US
Practice Address - Phone:859-481-7113
Practice Address - Fax:859-481-7114
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000316729OtherANTHEM
KY64065865Medicaid
KY50005469OtherPASSPORT
KY64065865Medicaid
KY0693557Medicare ID - Type Unspecified