MEDICARE: IMAD ISSAWI M.D.

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	207RC0000X	Cardiovascular Disease Physician	4301406524	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1042237	OTHER		HEALTH PLUS

General Provider Information

NPI Number	:	1174590228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMAD ISSAWI M.D.

Provider Business Mailing Address
First Line	:	6122 W PIERSON RD
Second Line	:	UNIT 1
City	:	FLUSHING
State	:	MI
Zip	:	48433-3104
Country	:	US
Telephone Number	:	810-600-3399
Fax Number	:	810-600-3398

Provider Business Practice Location Address
First Line	:	6122 W PIERSON RD
Second Line	:	UNIT 1
City	:	FLUSHING
State	:	MI
Zip	:	48433-3104
Country	:	US
Telephone Number	:	810-600-3399
Fax Number	:	810-600-3398

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	06/03/2016

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