MEDICARE: DR. MICHAEL HADDAD DDS

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	1223G0001X	General Practice Dentistry	290160089	MI

General Provider Information

NPI Number	:	1821668302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL HADDAD DDS

Provider Business Mailing Address
First Line	:	1016 AUDUBON RD
Second Line	:
City	:	GROSSE POINTE PARK
State	:	MI
Zip	:	48230-1407
Country	:	US
Telephone Number	:	313-530-2987
Fax Number	:

Provider Business Practice Location Address
First Line	:	51725 VAN DYKE AVE
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-4451
Country	:	US
Telephone Number	:	568-739-6400
Fax Number	:

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

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	06/28/2021

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