Provider Demographics
NPI:1316097314
Name:HADDADIN, MAEN (MD)
Entity type:Individual
Prefix:
First Name:MAEN
Middle Name:
Last Name:HADDADIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 BELLEVUE MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 145A
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123
Mailing Address - Country:US
Mailing Address - Phone:402-779-7207
Mailing Address - Fax:402-779-7210
Practice Address - Street 1:17030 LAKESIDE HILLS PLZ STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4656
Practice Address - Country:US
Practice Address - Phone:402-758-5800
Practice Address - Fax:402-758-5809
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32042207Q00000X
NE26986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025944600Medicaid