Provider Demographics
NPI:1730157660
Name:HADDAD, DANIEL S (MD,PC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 E BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1225
Mailing Address - Country:US
Mailing Address - Phone:248-689-4247
Mailing Address - Fax:248-689-4044
Practice Address - Street 1:355 E BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1225
Practice Address - Country:US
Practice Address - Phone:248-689-4247
Practice Address - Fax:248-689-4044
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301405654207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1954551Medicaid
MI0630771Medicare ID - Type Unspecified
MI1954551Medicaid