Active NPI
Louai Haddad, D.D.S
- Periodontics
- Chicago, IL
National Provider Identifier
1356801989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 019034312
- Practice address
- 3009 E 92ND St
Chicago, IL 60617-4502 - Phone
- (860) 960-9560
- NPI assigned
- Mar 20, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 019034312 | IL | Primary |
Addresses
Primary practice location
3009 E 92ND St
Chicago, IL 60617-4502
Mailing address
Faisal Farhan Al Jarba Street
Tlaa Al Ali Building Number 52
Amman, AMMAN 11953
JO
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190717003119 | CT | Order and Referring Only - Dentist | 4385979061 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019034312 | IL | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686528000000",
"number": "1356801989",
"addresses": [
{
"country_code": "JO",
"country_name": "Jordan",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "FAISAL FARHAN AL JARBA STREET",
"address_2": "TLAA AL ALI BUILDING NUMBER 52",
"city": "AMMAN",
"state": "AMMAN",
"postal_code": "11953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3009 E 92ND ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606174502",
"telephone_number": "860-960-9560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HADDAD",
"first_name": "LOUAI",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-20",
"last_updated": "2023-06-12",
"certification_date": "2023-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": "019034312",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.