Provider Demographics
NPI:1760572002
Name:HAIDER, MOHAMMED D (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:D
Last Name:HAIDER
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 1:500 OSBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1822
Mailing Address - Country:US
Mailing Address - Phone:906-635-4654
Mailing Address - Fax:
Practice Address - Street 1:509 OSBORN BLVD STE 340
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-2071
Practice Address - Country:US
Practice Address - Phone:906-632-5824
Practice Address - Fax:906-632-5818
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087221207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4934104Medicaid
MIMH087221OtherBCBSM
MIMH087221OtherBCBSM
MII66350Medicare UPIN