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General NPI Number Information
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NPI Number | 1427105469
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Entity Type | Organization
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Legal Business Name | BIRMINGHAM DERMATOLOGY, P.C.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2151 E 14 MILE RD
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City | BIRMINGHAM
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State | MI
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Zip | 48009-7260
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Country | US
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Telephone | 248-645-0830
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Fax | 248-645-2863
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Provider Business Mailing Address
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Address Line | 2151 E 14 MILE RD
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City | BIRMINGHAM
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State | MI
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Zip | 48009-7260
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Country | US
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Telephone | 248-645-0830
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Fax | 248-645-2863
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LORI HADDAD
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Credential | D.O.
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Telephone | 248-645-0830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | LH010584
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License Number State | MI
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