| Housam I Haddad Medical Practice, Pllc | |
|
187 Wolford Ave Liberty KY 42539-3278 | |
| (859) 327-7283 | |
| (800) 591-6398 |
| Full Name | Housam I Haddad Medical Practice, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 187 Wolford Ave, Liberty, Kentucky |
| Authorized Official Name and Position | Housam I Haddad (OWNER) |
| Authorized Official Contact | 8593277283 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Housam I Haddad Medical Practice, Pllc Po Box 1519 Liberty KY 42539-1519 Ph: (859) 327-7283 | Housam I Haddad Medical Practice, Pllc 187 Wolford Ave Liberty KY 42539-3278 Ph: (859) 327-7283 |
| NPI Number | 1285909788 |
|---|---|
| Provider Enumeration Date | 03/15/2012 |
| Last Update Date | 12/21/2016 |
| Medicare PECOS PAC ID | 0547422933 |
|---|---|
| Medicare Enrollment ID | O20120501000460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285909788 | NPI | - | NPPES |
| 64315310 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 31531 (Kentucky) | Primary |
| Provider Name | Housam I Haddad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467422253 PECOS PAC ID: 3476516642 Enrollment ID: I20041109000789 |
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