Provider Demographics
NPI:1750460143
Name:HADI, SUHAD (DPM)
Entity Type:Individual
Prefix:
First Name:SUHAD
Middle Name:
Last Name:HADI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 FOLSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5219
Mailing Address - Country:US
Mailing Address - Phone:916-733-3333
Mailing Address - Fax:
Practice Address - Street 1:3160 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5219
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4462213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00E44620OtherBLUE SHIELD
CA9781330OtherCIGNA
CAMCMG238900OtherWESTERN HEALTH ADVANTAGE
CA90132937OtherPACIFICARE
CA000E44620Medicaid
CA2097685OtherFIRST HEALTH
CA7305152OtherAETNA
CA90812OtherINTERPLAN
CAE4462OtherBLUE CROSS
CA098993OtherHEALTH NET
CA1708142OtherGREAT WEST
CA2025418OtherUNITED HEALTHCARE
CA90132937OtherPACIFICARE
CA00E44620OtherBLUE SHIELD