Healthcare Provider Details

I. General information

NPI: 1356148423
Provider Name (Legal Business Name): MARIAM HUSSEIN HACHEM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 AUTO CLUB DR STE 101
DEARBORN MI
48126-2749
US

IV. Provider business mailing address

5833 STEADMAN ST
DEARBORN MI
48126-2050
US

V. Phone/Fax

Practice location:
  • Phone: 313-753-7350
  • Fax:
Mailing address:
  • Phone: 313-753-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: