Healthcare Provider Details

I. General information

NPI: 1477149623
Provider Name (Legal Business Name): MICHAEL JOSEPH HADDAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S AVENUE A
YUMA AZ
85364-7127
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7127
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-2000
  • Fax:
Mailing address:
  • Phone: 928-344-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number012461
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: