Healthcare Provider Details

I. General information

NPI: 1902446479
Provider Name (Legal Business Name): HADI AWAD PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5688 N TELEGRAPH RD
DEARBORN HEIGHTS MI
48127-3219
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 313-633-9586
  • Fax: 313-633-9589
Mailing address:
  • Phone: 586-350-2644
  • Fax: 586-541-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502004927
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: