Provider Demographics
NPI:1972961001
Name:HADIS, KADAR
Entity Type:Individual
Prefix:
First Name:KADAR
Middle Name:
Last Name:HADIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 HUMBOLDT AVE S STE 217
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1432
Mailing Address - Country:US
Mailing Address - Phone:952-992-0354
Mailing Address - Fax:
Practice Address - Street 1:8200 HUMBOLDT AVE S STE 217
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431
Practice Address - Country:US
Practice Address - Phone:952-992-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86708300035343900000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)