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General NPI Number Information
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NPI Number | 1679987424
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASES CONSULTANTS OF DETROIT PC
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 23077 GREENFIELD RD SUITE 479
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3709
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Country | US
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Telephone | 248-557-4129
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Fax | 248-557-4599
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Provider Business Mailing Address
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Address Line | 23077 GREENFIELD RD SUITE 479
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3709
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Country | US
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Telephone | 248-557-4129
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Fax | 248-557-4599
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Authorized Official
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Title or Position | OWNER
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Name | DR. HANADY DAAS
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Credential | M.D.
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Telephone | 313-663-9321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 4301104261
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License Number State | MI
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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 | 4301088353
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License Number State | MI
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