Provider Demographics
NPI:1194819029
Name:HADDAD, FAWAZ E (MD)
Entity type:Individual
Prefix:DR
First Name:FAWAZ
Middle Name:E
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8273 S SAGINAW ST
Mailing Address - Street 2:STE 8
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2465
Mailing Address - Country:US
Mailing Address - Phone:810-695-6565
Mailing Address - Fax:810-695-9476
Practice Address - Street 1:8273 S SAGINAW ST STE C
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2465
Practice Address - Country:US
Practice Address - Phone:810-695-6565
Practice Address - Fax:810-695-9476
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063791208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4675100Medicaid
N72340004Medicare ID - Type Unspecified
G75696Medicare UPIN