Provider Demographics
NPI:1851313803
Name:HADDADIN, ISAM ANDRAWGS (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:ISAM
Middle Name:ANDRAWGS
Last Name:HADDADIN
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322
Mailing Address - Country:US
Mailing Address - Phone:219-923-2100
Mailing Address - Fax:219-923-9342
Practice Address - Street 1:3641 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322
Practice Address - Country:US
Practice Address - Phone:219-923-2100
Practice Address - Fax:219-923-9342
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029890A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
87493OtherBLUE CROSS BLUE SHIELD
IL91108082OtherBLUE CROSS BLUE SHIELD
IN100168870AMedicaid
IL91108082OtherBLUE CROSS BLUE SHIELD
IN100168870AMedicaid