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NPI Code Detail

MEDICARE: HISHAM AHMAD KADDURAH

MEDICARE: HISHAM AHMAD KADDURAH
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
12085R0202XDiagnostic Radiology Physician4301507319MI

General Provider Information

NPI Number : 1376004325
Entity Type Code : Individual
Provider Name (Legal Business Name) : HISHAM AHMAD KADDURAH
Provider Business Mailing Address
First Line : 26300 TELEGRAPH RD STE 200
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-5367
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 GENESYS PKWY
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-8065
Country : US
Telephone Number : 810-606-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2019
Last Update Date : 01/07/2026

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