Provider Demographics
NPI:1669442695
Name:ELHADY, HATEM SALEH (MD)
Entity Type:Individual
Prefix:DR
First Name:HATEM
Middle Name:SALEH
Last Name:ELHADY
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 1:1625 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-4155
Mailing Address - Country:US
Mailing Address - Phone:734-864-4797
Mailing Address - Fax:734-864-4755
Practice Address - Street 1:921 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-2020
Practice Address - Country:US
Practice Address - Phone:419-673-0761
Practice Address - Fax:419-673-9366
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-9655-E207P00000X
MI4301077509207R00000X
OH35.079655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2262733Medicaid
OH5619197341C1VOtherBLUECROSS BLUESHIELD
MI1669442695Medicaid
OH4094412Medicare PIN