Basic Information
| Provider Information | |||||||||
| NPI: | 1962600098 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KADDOUM | ||||||||
| FirstName: | ROMEO | ||||||||
| MiddleName: | NAZIH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3737 BEAUBIEN ST | ||||||||
| Address2: | INTERNATIONAL GUEST HOUSING APT 908 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135985979 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3990 JOHN R ST | ||||||||
| Address2: | HARPER HOSPITAL ROOM 2901 BOX 162 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137457233 | ||||||||
| FaxNumber: | 3139933889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 07/10/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 4301088573 | MI | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.