Provider Demographics
NPI:1629247481
Name:MASRI, HAITHAM (MD)
Entity Type:Individual
Prefix:
First Name:HAITHAM
Middle Name:
Last Name:MASRI
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 1:13530 MICHIGAN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3574
Mailing Address - Country:US
Mailing Address - Phone:313-945-9800
Mailing Address - Fax:313-945-9184
Practice Address - Street 1:13530 MICHIGAN AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-945-9800
Practice Address - Fax:313-945-9184
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHM052487174400000X
MI4301052487207Y00000X, 207YS0012X, 207YX0007X, 207YX0602X, 208200000X, 2086S0122X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No174400000XOther Service ProvidersSpecialist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0408205571OtherBCBS IND
MIP10167081OtherRAILROAD MEDICARE
MI1629247481Medicaid
MI4867754Medicaid
MI700H228180OtherBLUE CROSS BLUE SHIELD MI
MI4867754Medicaid
MI0P30670Medicare PIN
MIP10167081OtherRAILROAD MEDICARE