Provider Demographics
NPI:1962600098
Name:KADDOUM, ROMEO NAZIH (MD)
Entity type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:NAZIH
Last Name:KADDOUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3737 BEAUBIEN ST
Mailing Address - Street 2:INTERNATIONAL GUEST HOUSING APT 908
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2152
Mailing Address - Country:US
Mailing Address - Phone:313-598-5979
Mailing Address - Fax:
Practice Address - Street 1:3990 JOHN R ST
Practice Address - Street 2:HARPER HOSPITAL ROOM 2901 BOX 162
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2018
Practice Address - Country:US
Practice Address - Phone:313-745-7233
Practice Address - Fax:313-993-3889
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301088573207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology