Healthcare Provider Details

I. General information

NPI: 1275001521
Provider Name (Legal Business Name): SAAD UDDIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9641 HARPER AVE
DETROIT MI
48213-2731
US

IV. Provider business mailing address

9641 HARPER AVE
DETROIT MI
48213-2731
US

V. Phone/Fax

Practice location:
  • Phone: 313-875-7601
  • Fax:
Mailing address:
  • Phone: 313-875-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802089680
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: