Provider Demographics
NPI:1265415285
Name:DAHER, EMAD (MD)
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:
Last Name:DAHER
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 1:1210 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3406
Mailing Address - Country:US
Mailing Address - Phone:810-662-3505
Mailing Address - Fax:
Practice Address - Street 1:1210 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3406
Practice Address - Country:US
Practice Address - Phone:810-662-3505
Practice Address - Fax:810-662-3479
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I13847Medicare UPIN
0P55730Medicare PIN
0N96280Medicare PIN