Provider Demographics
NPI:1427446574
Name:EMAM, HAITHEM
Entity type:Individual
Prefix:
First Name:HAITHEM
Middle Name:
Last Name:EMAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 SE PARKVIEW CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9551
Mailing Address - Country:US
Mailing Address - Phone:313-622-2992
Mailing Address - Fax:
Practice Address - Street 1:1940 SE PARKVIEW CROSSING DR
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9551
Practice Address - Country:US
Practice Address - Phone:313-622-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist