Provider Demographics
NPI:1679987424
Name:INFECTIOUS DISEASES CONSULTANTS OF DETROIT PC
Entity type:Organization
Organization Name:INFECTIOUS DISEASES CONSULTANTS OF DETROIT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANADY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-663-9321
Mailing Address - Street 1:23077 GREENFIELD RD
Mailing Address - Street 2:SUITE 479
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3709
Mailing Address - Country:US
Mailing Address - Phone:248-557-4129
Mailing Address - Fax:248-557-4599
Practice Address - Street 1:23077 GREENFIELD RD
Practice Address - Street 2:SUITE 479
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3709
Practice Address - Country:US
Practice Address - Phone:248-557-4129
Practice Address - Fax:248-557-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088353207RI0200X
MI4301104261207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty