MEDICARE: MRS. ATHRAA HADDAD

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	172V00000X	Community Health Worker		MI

General Provider Information

NPI Number	:	1346644556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ATHRAA HADDAD

Provider Business Mailing Address
First Line	:	36843 KYRO CT
Second Line	:
City	:	STERLING HTS
State	:	MI
Zip	:	48310-4600
Country	:	US
Telephone Number	:	586-601-6434
Fax Number	:

Provider Business Practice Location Address
First Line	:	36843 KYRO CT
Second Line	:
City	:	STERLING HTS
State	:	MI
Zip	:	48310-4600
Country	:	US
Telephone Number	:	586-601-6434
Fax Number	:

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

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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