Provider Demographics
NPI:1568638047
Name:M HAITHAM AL-MIDANI MD PC
Entity Type:Organization
Organization Name:M HAITHAM AL-MIDANI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:HAITHAM
Authorized Official - Last Name:AL-MIDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-743-0680
Mailing Address - Street 1:4050 WALLI STRASSE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1727
Mailing Address - Country:US
Mailing Address - Phone:810-743-0680
Mailing Address - Fax:810-743-0020
Practice Address - Street 1:4050 WALLI STRASSE DR STE 1
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1727
Practice Address - Country:US
Practice Address - Phone:810-743-0680
Practice Address - Fax:810-743-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037021207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC2751OtherMCARE
MI1002512771OtherBCBS
MI212241OtherMCLAREN HEALTH PLAN
MIA75929OtherHEALTH ALLIANCE PLAN
MI1388637 TYPE 10Medicaid
MI30109OtherCARESOURCE
MI1100661OtherHEALTHPLUS
MI0251277OtherBCN
MIC2751OtherMCARE
MIA75929OtherHEALTH ALLIANCE PLAN