Provider Demographics
NPI:1184813941
Name:M. HAITHAM AL-MIDANI, MD PC
Entity type:Organization
Organization Name:M. HAITHAM AL-MIDANI, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:HAITHAM
Authorized Official - Last Name:AL-MIDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-743-0680
Mailing Address - Street 1:4050 WALLI STRASSE DR
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1727
Mailing Address - Country:US
Mailing Address - Phone:810-743-0680
Mailing Address - Fax:
Practice Address - Street 1:4050 WALLI STRASSE DR
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1727
Practice Address - Country:US
Practice Address - Phone:810-743-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037021207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1002512771OtherBLUE CARE NETWORK
MI1100661OtherHEALTHPLUS
MIC2751OtherMCARE
MI02500611OtherBLUE CROSS BLUE SHIELD
MI1388637Medicaid
MI1002512771OtherBLUE CARE NETWORK
MI02500611OtherBLUE CROSS BLUE SHIELD