Healthcare Provider Details

I. General information

NPI: 1154749232
Provider Name (Legal Business Name): HAIDER RAHBAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 WATER ST
PORT HURON MI
48060-4408
US

IV. Provider business mailing address

2799 W GRAND BLVD HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 810-984-4194
  • Fax: 810-984-4674
Mailing address:
  • Phone: 313-916-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301500235
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: