Healthcare Provider Details

I. General information

NPI: 1528249224
Provider Name (Legal Business Name): HIAM NHME M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12813 W WARREN AVE
DEARBORN MI
48126-1532
US

IV. Provider business mailing address

2714 SADLER DR
WARREN MI
48092-1846
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-8090
  • Fax: 313-581-4823
Mailing address:
  • Phone: 248-417-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number4301085754
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: