Healthcare Provider Details

I. General information

NPI: 1952713125
Provider Name (Legal Business Name): SHAHD HAIDAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MCAULEY DR RM 2009
YPSILANTI MI
48197-1095
US

IV. Provider business mailing address

5333 MCAULEY DR RM 2009
YPSILANTI MI
48197-1095
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-0050
  • Fax: 734-712-0050
Mailing address:
  • Phone: 734-712-0050
  • Fax: 734-712-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301114648
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: