Healthcare Provider Details

I. General information

NPI: 1780056549
Provider Name (Legal Business Name): MOHAMMAD KISRA HADDAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30901 PALMER RD
WESTLAND MI
48186-9529
US

IV. Provider business mailing address

30901 PALMER RD
WESTLAND MI
48186-9529
US

V. Phone/Fax

Practice location:
  • Phone: 734-367-8400
  • Fax:
Mailing address:
  • Phone: 734-367-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101027346
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: