Healthcare Provider Details

I. General information

NPI: 1851650782
Provider Name (Legal Business Name): GHADA HARSOUNI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2012
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GREEN RD STE H
ANN ARBOR MI
48105-1569
US

IV. Provider business mailing address

2200 GREEN RD STE H
ANN ARBOR MI
48105-1569
US

V. Phone/Fax

Practice location:
  • Phone: 734-531-8299
  • Fax: 856-212-1115
Mailing address:
  • Phone: 734-531-8299
  • Fax: 856-212-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number4301110025
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301110025
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: