Provider Demographics
NPI:1780754358
Name:HADDAD, GHASSAN GEORGES (MD)
Entity type:Individual
Prefix:
First Name:GHASSAN
Middle Name:GEORGES
Last Name:HADDAD
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 1:6200SW73RD ST
Mailing Address - Street 2:BOX 69
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4679
Mailing Address - Country:US
Mailing Address - Phone:786-662-5465
Mailing Address - Fax:786-662-5334
Practice Address - Street 1:6200 SW 73RD ST
Practice Address - Street 2:BOX 69
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4679
Practice Address - Country:US
Practice Address - Phone:786-662-5465
Practice Address - Fax:786-662-5334
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258970200Medicaid
FLH16938Medicare UPIN
FL258970200Medicaid