Healthcare Provider Details

I. General information

NPI: 1255994612
Provider Name (Legal Business Name): BATOUL KASSEM BAIDOUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2196
US

IV. Provider business mailing address

21 WILLIAMSON CT
DEARBORN MI
48126-2126
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-1892
  • Fax: 313-993-7118
Mailing address:
  • Phone: 313-515-9549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301507030
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: