1164620753 NPI number — RIAD R. HAJJAR MD PC

Table of content: (NPI 1164620753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164620753 NPI number — RIAD R. HAJJAR MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIAD R. HAJJAR 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:
Provider Other Organization Name Type Code:
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:
1164620753
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 STONE ST
Provider Second Line Business Mailing Address:
STE 5
Provider Business Mailing Address City Name:
PORT HURON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48060-3563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-966-9556
Provider Business Mailing Address Fax Number:
810-966-4898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 STONE ST
Provider Second Line Business Practice Location Address:
STE 5
Provider Business Practice Location Address City Name:
PORT HURON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48060-3563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-966-9556
Provider Business Practice Location Address Fax Number:
810-966-4898
Provider Enumeration Date:
07/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KLANN
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
810-966-9556

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  RH066725 , 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: D5959 . This is a "PALMETTO GBA-RAILROAD MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 207R00000X . This is a "TAXONOMY CODE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4263408 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com