Organization
STANFORD WELLCARE CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IMAD A HADDAD MD (OWNER)
(859) 481-7113
Entity
Organization
Contact information
Practice address
132 FRONTIER BLVD STE 101, STANFORD, KY 40484-6516
(606) 727-5757
(606) 727-5777
Mailing address
132 FRONTIER BLVD STE 101, STANFORD, KY 40484-6516
(606) 727-5757
(606) 727-5777
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
04/05/2021
Last updated
08/03/2021
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