Healthcare Provider Details

I. General information

NPI: 1780105064
Provider Name (Legal Business Name): MICHAEL MARWAN HADDADIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S 45TH ST
OMAHA NE
68198-2002
US

IV. Provider business mailing address

986840 NEBRASKA MEDICAL CENTER
OMAHA NE
68198-2002
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-8013
  • Fax:
Mailing address:
  • Phone: 402-559-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35770
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: