Healthcare Provider Details

I. General information

NPI: 1144203753
Provider Name (Legal Business Name): HAIDAR KABBANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W CENTRAL AVENUE #101, #102, #103
TOLEDO OH
43606
US

IV. Provider business mailing address

2130 W CENTRAL AVE STE 101
TOLEDO OH
43606-3819
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-3900
  • Fax: 419-479-6055
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.096508
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number35.096508
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number35.096508
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: