Healthcare Provider Details

I. General information

NPI: 1881181402
Provider Name (Legal Business Name): MOHAMAD OMAR HADIED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 12/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 PARK CENTER CT.
TOLEDO OH
43615
US

IV. Provider business mailing address

5757 PARK CENTER CT.
TOLEDO OH
43615
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-4064
  • Fax: 419-472-2772
Mailing address:
  • Phone: 419-474-4064
  • Fax: 419-472-2772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35.14948
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: