Provider Demographics
NPI:1649619198
Name:HADDAD, JESSICA ROSE (MD)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ROSE
Last Name:HADDAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR LBBY J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:
Practice Address - Street 1:39201 7 MILE RD RM 140A
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1079
Practice Address - Country:US
Practice Address - Phone:734-213-3685
Practice Address - Fax:734-213-3686
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125.063411207Q00000X
MI4301110197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine