Provider Demographics
NPI:1174746424
Name:AL-HADDAD, SAFAA (MD)
Entity type:Individual
Prefix:
First Name:SAFAA
Middle Name:
Last Name:AL-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:PO BOX 901543
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44190-1543
Mailing Address - Country:US
Mailing Address - Phone:440-250-2070
Mailing Address - Fax:440-331-4063
Practice Address - Street 1:20575 CENTER RIDGE RD STE 500
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3422
Practice Address - Country:US
Practice Address - Phone:440-250-2070
Practice Address - Fax:440-331-4063
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2093747Medicaid
OH0860908Medicare PIN