Provider Demographics
NPI:1609026335
Name:SHAKER HADDAD MD PC
Entity Type:Organization
Organization Name:SHAKER HADDAD MD PC
Other - Org Name:SHAKER HADDAD MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAKER
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-581-8090
Mailing Address - Street 1:12813 WEST WARREN
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126
Mailing Address - Country:US
Mailing Address - Phone:313-581-8090
Mailing Address - Fax:313-581-4823
Practice Address - Street 1:12813 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1532
Practice Address - Country:US
Practice Address - Phone:313-581-8090
Practice Address - Fax:313-581-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISH048228261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1848906Medicaid