| Riad R. Hajjar Md Pc | |
|
1201 Stone St Ste 5 Port Huron MI 48060-3563 | |
| (810) 966-9556 | |
| (810) 966-4898 |
| Full Name | Riad R. Hajjar Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1201 Stone St, Port Huron, Michigan |
| Authorized Official Name and Position | Carol Klann (OFFICE MANAGER) |
| Authorized Official Contact | 8109669556 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riad R. Hajjar Md Pc 1201 Stone St Ste 5 Port Huron MI 48060-3563 Ph: (810) 966-9556 | Riad R. Hajjar Md Pc 1201 Stone St Ste 5 Port Huron MI 48060-3563 Ph: (810) 966-9556 |
| NPI Number | 1164620753 |
|---|---|
| Provider Enumeration Date | 07/05/2007 |
| Last Update Date | 12/17/2009 |
| Medicare PECOS PAC ID | 2365475712 |
|---|---|
| Medicare Enrollment ID | O20050915000577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164620753 | NPI | - | NPPES |
| D5959 | Other | PALMETTO GBA-RAILROAD MED | |
| 207R00000X | Other | MI | TAXONOMY CODE |
| 4263408 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | RH066725 (Michigan) | Primary |
| Provider Name | Riad R Hajjar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538153176 PECOS PAC ID: 2264466275 Enrollment ID: I20050920000482 |
| Provider Name | Roofan Alsayegh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477841641 PECOS PAC ID: 6507098530 Enrollment ID: I20140715000694 |
| Provider Name | Jaclyn Kamidoi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992202998 PECOS PAC ID: 9234476417 Enrollment ID: I20190125001233 |
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