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General NPI Number Information
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NPI Number | 1831366145
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Entity Type | Individual
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Provider Name | LYNDA HAIDAR-AHMAD PAC
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Gender | Female
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 24825 MICHIGAN AVE
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City | DEARBORN
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State | MI
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Zip | 48124-1757
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Country | US
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Telephone | 313-675-9447
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Fax |
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Provider Business Mailing Address
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Address Line | 6980 FAIRWOOD DR
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-1806
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Country | US
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Telephone | 313-675-9447
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601005236
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License Number State | MI
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