Healthcare Provider Details

I. General information

NPI: 1306662622
Provider Name (Legal Business Name): HADDAD PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12813 W WARREN AVE
DEARBORN MI
48126-1532
US

IV. Provider business mailing address

12813 W WARREN AVE
DEARBORN MI
48126-1532
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-8090
  • Fax: 313-581-4823
Mailing address:
  • Phone: 313-581-8090
  • Fax: 313-581-4823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LILLIANA HADDAD
Title or Position: OWNER
Credential: MD
Phone: 313-581-8090