Provider Demographics
NPI:1457407074
Name:HIATT, TADD KAEO (MD)
Entity type:Individual
Prefix:
First Name:TADD
Middle Name:KAEO
Last Name:HIATT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 SOUTH BLVD E STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6120
Mailing Address - Country:US
Mailing Address - Phone:248-884-9710
Mailing Address - Fax:248-884-9711
Practice Address - Street 1:1650 RAMBLEWOOD DR STE 300
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7396
Practice Address - Country:US
Practice Address - Phone:517-332-1200
Practice Address - Fax:517-351-7122
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100152207R00000X, 207RG0100X
CO46668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37770781Medicaid
CO37770781Medicaid
MIFH3136226OtherDEA
COC300904Medicare PIN