MEDICARE: LORETTE N HADDAD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	4301071140	MI

General Provider Information

NPI Number	:	1265472104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORETTE N HADDAD MD

Provider Business Mailing Address
First Line	:	4201 ST. ANTOINE - UHC 5D MAILBOX 226
Second Line	:	UNIVERSITY PEDIATRICIANS
City	:	DETROIT
State	:	MI
Zip	:	48201
Country	:	US
Telephone Number	:	313-745-4405
Fax Number	:	313-966-0665

Provider Business Practice Location Address
First Line	:	23801 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2236
Country	:	US
Telephone Number	:	313-908-5856
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	03/17/2018

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