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General NPI Number Information
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NPI Number | 1245849892
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Entity Type | Individual
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Provider Name | MOHAMMAD HAIDOUS MD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 611 E DOUGLAS RD STE 309
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City | MISHAWAKA
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State | IN
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Zip | 46545-1467
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Country | US
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Telephone | 574-335-6770
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Fax | 574-335-0779
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Provider Business Mailing Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-844-3833
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 57.249573
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 01096548A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A185951
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License Number State | CA
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