Provider Demographics
NPI:1538456660
Name:HADER, ISMAIL M (MD)
Entity Type:Individual
Prefix:
First Name:ISMAIL
Middle Name:M
Last Name:HADER
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 1:215 KINGWOOD EXECUTIVE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2765
Mailing Address - Country:US
Mailing Address - Phone:281-869-3690
Mailing Address - Fax:281-869-3659
Practice Address - Street 1:215 KINGWOOD EXECUTIVE DR STE 250
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2765
Practice Address - Country:US
Practice Address - Phone:281-869-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-10
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103117207R00000X
OH57.017380207R00000X
TXU3225207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine