MEDICARE: DR. ISSA T. HADDAD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	BH7862089	MI

General Provider Information

NPI Number	:	1124091376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISSA T. HADDAD MD

Provider Business Mailing Address
First Line	:	9720 DIX
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48120-1566
Country	:	US
Telephone Number	:	313-841-1680
Fax Number	:	313-841-3123

Provider Business Practice Location Address
First Line	:	9720 DIX
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48120-1566
Country	:	US
Telephone Number	:	313-841-1680
Fax Number	:	313-841-3123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	11/15/2012

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