Provider Demographics
NPI:1952364242
Name:HATAHET, MOHAMAD AMMAR (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:AMMAR
Last Name:HATAHET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4000 HIGHLAND RD
Mailing Address - Street 2:STE 110
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2167
Mailing Address - Country:US
Mailing Address - Phone:248-681-2226
Mailing Address - Fax:248-681-6494
Practice Address - Street 1:4000 HIGHLAND RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2167
Practice Address - Country:US
Practice Address - Phone:248-681-2226
Practice Address - Fax:248-681-6494
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-09
Last Update Date:2014-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301056359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4671246Medicaid
0P47390Medicare PIN
MI4671246Medicaid