Healthcare Provider Details

I. General information

NPI: 1184996738
Provider Name (Legal Business Name): KEEGO HARBOR ORTHOPEDIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2012
Last Update Date: 01/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 ORCHARD LAKE RD
KEEGO HARBOR MI
48320-1315
US

IV. Provider business mailing address

3435 ORCHARD LAKE RD
KEEGO HARBOR MI
48320-1315
US

V. Phone/Fax

Practice location:
  • Phone: 248-977-4516
  • Fax: 248-977-4549
Mailing address:
  • Phone: 248-977-4516
  • Fax: 248-977-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301033029
License Number StateMI

VIII. Authorized Official

Name: DR. AHMAD HADIED
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 734-693-4011