Healthcare Provider Details

I. General information

NPI: 1609026335
Provider Name (Legal Business Name): SHAKER HADDAD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
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

12813 WEST WARREN
DEARBORN MI
48126
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 Code261Q00000X
TaxonomyClinic/Center
License NumberSH048228
License Number StateMI

VIII. Authorized Official

Name: MR. SHAKER HADDAD
Title or Position: MD
Credential: MD
Phone: 313-581-8090