Healthcare Provider Details

I. General information

NPI: 1306854534
Provider Name (Legal Business Name): IHAB HADDADIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE HB6
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE HB6
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-0617
  • Fax:
Mailing address:
  • Phone: 216-444-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number48904
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number48904
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: