Provider Demographics
NPI:1063908077
Name:HAIDAR, AKHLEMA PARU (DO)
Entity type:Individual
Prefix:
First Name:AKHLEMA
Middle Name:PARU
Last Name:HAIDAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22201 MOROSS RD STE 50
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2166
Mailing Address - Country:US
Mailing Address - Phone:313-343-7774
Mailing Address - Fax:313-343-8747
Practice Address - Street 1:1000 HARRINGTON ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2920
Practice Address - Country:US
Practice Address - Phone:586-493-8142
Practice Address - Fax:586-493-3250
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101024109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine