Provider Demographics
NPI:1518369412
Name:RAED HADDAD MD, PLLC
Entity Type:Organization
Organization Name:RAED HADDAD MD, PLLC
Other - Org Name:HADDAD INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAED
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-843-1960
Mailing Address - Street 1:9720 DIX STE B
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:313-843-1973
Mailing Address - Fax:313-843-1961
Practice Address - Street 1:9720 DIX STE B
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120
Practice Address - Country:US
Practice Address - Phone:313-843-1973
Practice Address - Fax:313-843-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1023320231Medicaid
MI1023320231Medicaid