# AHMAD ABDALI HAIDAR MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497391288
- **Authorized official:** ALLYSON WIRTZ (PROVIDER ENROLLMENT)
- **Authorized official phone:** (337) 408-0805

## Contact information

- **Practice address:** 600 GOLF COURSE DR., CARRIERE, MS 39426
- **Practice address phone:** (601) 699-9846
- **Practice address fax:** (601) 799-0052
- **Mailing address:** 1509 DULLES DR, LAFAYETTE, LA 70506-3718
- **Mailing address phone:** (337) 991-9276
- **Mailing address fax:** (337) 943-0846

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/27/2019
- **Last updated:** 08/17/2022