Provider Demographics
NPI:1871051516
Name:HADID MEDICINE LLC
Entity type:Organization
Organization Name:HADID MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JABR
Authorized Official - Middle Name:
Authorized Official - Last Name:HADID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-327-0617
Mailing Address - Street 1:357 SOUTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4046
Mailing Address - Country:US
Mailing Address - Phone:330-327-0617
Mailing Address - Fax:
Practice Address - Street 1:3033 SARNO RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7229
Practice Address - Country:US
Practice Address - Phone:330-327-0617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME134575OtherMEDICAL LICENSE