Provider Demographics
NPI:1750371621
Name:HADDAD, CHADI G (DO)
Entity type:Individual
Prefix:
First Name:CHADI
Middle Name:G
Last Name:HADDAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3222
Mailing Address - Country:US
Mailing Address - Phone:313-561-2200
Mailing Address - Fax:313-561-2211
Practice Address - Street 1:6221 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3222
Practice Address - Country:US
Practice Address - Phone:313-561-2200
Practice Address - Fax:313-561-2211
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014742207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4618786Medicaid
MI4618786Medicaid
MI0Q26334056Medicare PIN