Healthcare Provider Details

I. General information

NPI: 1265415285
Provider Name (Legal Business Name): EMAD DAHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 10TH AVE
PORT HURON MI
48060-3406
US

IV. Provider business mailing address

1210 10TH AVE
PORT HURON MI
48060-3406
US

V. Phone/Fax

Practice location:
  • Phone: 810-662-3505
  • Fax: 810-662-3479
Mailing address:
  • Phone: 810-662-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301076169
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: