Provider Demographics
NPI:1689938789
Name:DAHER, ROULA (MD)
Entity Type:Individual
Prefix:
First Name:ROULA
Middle Name:
Last Name:DAHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 S MILITARY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2107
Mailing Address - Country:US
Mailing Address - Phone:313-274-3311
Mailing Address - Fax:313-274-3587
Practice Address - Street 1:751 S MILITARY ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-274-3311
Practice Address - Fax:313-274-3587
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101430208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics