MEDICARE: RIAD ROBERT HAJJAR M.D.

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	207R00000X	Internal Medicine Physician	RH066725	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538153176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIAD ROBERT HAJJAR M.D.

Provider Business Mailing Address
First Line	:	1201 STONE ST
Second Line	:	STE. 5
City	:	PORT HURON
State	:	MI
Zip	:	48060-3563
Country	:	US
Telephone Number	:	810-966-9556
Fax Number	:	810-966-4898

Provider Business Practice Location Address
First Line	:	1201 STONE ST
Second Line	:	STE. 5
City	:	PORT HURON
State	:	MI
Zip	:	48060-3563
Country	:	US
Telephone Number	:	810-966-9556
Fax Number	:	810-966-4898

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/08/2007

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