Healthcare Provider Details

I. General information

NPI: 1689938789
Provider Name (Legal Business Name): ROULA DAHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S MILITARY ST
DEARBORN MI
48124
US

IV. Provider business mailing address

751 S MILITARY ST
DEARBORN MI
48124-2107
US

V. Phone/Fax

Practice location:
  • Phone: 313-274-3311
  • Fax: 313-274-3587
Mailing address:
  • Phone: 313-274-3311
  • Fax: 313-274-3587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301101430
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number4301101430
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: