Provider Demographics
NPI:1649015694
Name:HAMAD, BAYAN AMELIA
Entity type:Individual
Prefix:
First Name:BAYAN
Middle Name:AMELIA
Last Name:HAMAD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 MADA COURT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:980-319-5271
Mailing Address - Fax:
Practice Address - Street 1:15120 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-843-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601012416OtherSTATE OF MICHIGAN- DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS