Provider Demographics
NPI:1023320231
Name:HADDAD, RAED (MD)
Entity type:Individual
Prefix:
First Name:RAED
Middle Name:
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 DIX
Mailing Address - Street 2:STE B
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1566
Mailing Address - Country:US
Mailing Address - Phone:313-843-1973
Mailing Address - Fax:313-843-1961
Practice Address - Street 1:9720 DIX
Practice Address - Street 2:STE B
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1566
Practice Address - Country:US
Practice Address - Phone:313-843-1973
Practice Address - Fax:313-843-1961
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1023320231OtherHAP
MI1023320231Medicaid
MI1023320231OtherBCBS
MI1518369412Medicare PIN