Healthcare Provider Details

I. General information

NPI: 1871597393
Provider Name (Legal Business Name): HANY W HADDAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12995 BRIGHTON AVE
CARMEL IN
46032-8642
US

IV. Provider business mailing address

12995 BRIGHTON AVE
CARMEL IN
46032-8642
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-2212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01029331A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number01029331A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: