Provider Demographics
NPI:1356148423
Name:HACHEM, MARIAM HUSSEIN
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:HUSSEIN
Last Name:HACHEM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 STEADMAN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2050
Mailing Address - Country:US
Mailing Address - Phone:313-753-7350
Mailing Address - Fax:
Practice Address - Street 1:1903 W MICHIGAN AVE
Practice Address - Street 2:PHYSICIAN ASSISTANT DEPARTMENT
Practice Address - City:KALAMZOO
Practice Address - State:MI
Practice Address - Zip Code:49008
Practice Address - Country:US
Practice Address - Phone:269-387-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant