Provider Demographics
NPI:1366527160
Name:AL-MIDANI, MUHAMMAD HAITHAM (MD FACP)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:HAITHAM
Last Name:AL-MIDANI
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:HAITHAM
Other - Last Name:AL-MIDANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD FACP
Mailing Address - Street 1:4050 WALLI STRASSE DR
Mailing Address - Street 2:STE 1
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1727
Mailing Address - Country:US
Mailing Address - Phone:810-743-0680
Mailing Address - Fax:810-743-0020
Practice Address - Street 1:4050 WALLI STRASSE DR
Practice Address - Street 2:STE 1
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1727
Practice Address - Country:US
Practice Address - Phone:810-743-0680
Practice Address - Fax:810-743-0020
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMA037021207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1100661OtherHEALTH PLUS OF MI
MI1388637Medicaid
MI02500611OtherBLUE CROSS BLUE SHIELD
MI02500661OtherBLUE CARE NETWORK
MIC2751OtherM-CARE
MI02500611OtherBLUE CROSS BLUE SHIELD
MIC2751OtherM-CARE