Basic Information
Provider Information
NPI: 1003294844
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAMADE
FirstName: MAYSA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3621 S STATE ST
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481081633
CountryCode: US
TelephoneNumber: 7346475299
FaxNumber:  
Practice Location
Address1: 1500 E MEDICAL CENTER DR
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481095000
CountryCode: US
TelephoneNumber: 7349364000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/13/2015
LastUpdateDate: 07/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X4301107376MIN Allopathic & Osteopathic PhysiciansPediatrics 
2084N0400X4301502807MIY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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