1720262488 NPI number — DANIEL S HADDAD, MD,PC

Table of content: (NPI 1720262488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720262488 NPI number — DANIEL S HADDAD, MD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL S HADDAD, MD,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LASER EYE INSTITUTE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720262488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 E BIG BEAVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48083-1210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-689-4247
Provider Business Mailing Address Fax Number:
248-689-4044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 E BIG BEAVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48083-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-689-4247
Provider Business Practice Location Address Fax Number:
248-689-4044
Provider Enumeration Date:
12/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HADDAD
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
248-689-2020

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  DH405654 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1954542 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com