1568638047 NPI number — M HAITHAM AL-MIDANI MD PC

Table of content: (NPI 1568638047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568638047 NPI number — M HAITHAM AL-MIDANI MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M HAITHAM AL-MIDANI 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:
1568638047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4050 WALLI STRASSE DR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48509-1727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-743-0680
Provider Business Mailing Address Fax Number:
810-743-0020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4050 WALLI STRASSE DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48509-1727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-743-0680
Provider Business Practice Location Address Fax Number:
810-743-0020
Provider Enumeration Date:
05/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AL-MIDANI
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
HAITHAM
Authorized Official Title or Position:
PRESIDENT / PHYSICIAN
Authorized Official Telephone Number:
810-743-0680

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  4301037021 , 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: C2751 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1002512771 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 212241 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: A75929 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1388637 TYPE 10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30109 . This is a "CARESOURCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1100661 . This is a "HEALTHPLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0251277 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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