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NPI Code Detail

MEDICARE: LYNDA HAIDAR-AHMAD PAC

MEDICARE:   LYNDA  HAIDAR-AHMAD  PAC
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
1363AM0700XMedical Physician Assistant5601005236MI

General Provider Information

NPI Number : 1831366145
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNDA HAIDAR-AHMAD PAC
Provider Business Mailing Address
First Line : 6980 FAIRWOOD DR
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48127-1806
Country : US
Telephone Number : 313-675-9447
Fax Number :
Provider Business Practice Location Address
First Line : 24825 MICHIGAN AVE
Second Line :
City : DEARBORN
State : MI
Zip : 48124-1757
Country : US
Telephone Number : 313-675-9447
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2008
Last Update Date : 11/07/2013

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Directions to “ LYNDA HAIDAR-AHMAD PAC” Practice Location

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