DR. KELLY JEANE HAIDAR DO
NPI 1508557968
Student in an Organized Health Care Education/Training Program in Canton, MI

Q: What is Kelly Haidar's NPI number?

The NPI number for Kelly Haidar is 1508557968. It was assigned to this individual provider in the NPPES registry on May 17, 2023.

Q: What is Kelly Haidar's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Haidar was last updated on May 17, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 17, 2023PECOS Enrolled

1051 N CANTON CENTER RD, CANTON, MI 48187(734) 539-5080 Get Directions Write a Review

NPPES record last updated: May 17, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dr. Kelly Jeane Haidar Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLY JEANE HAIDAR DO (NPI 1508557968) is an individual student in an organized health care education/training program in Canton, Michigan, licensed in Michigan (5151016046) and active in the NPI registry since May 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1508557968

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameDR. KELLY JEANE HAIDARCredential: DO

Location Address1051 N CANTON CENTER RDCanton, MI 48187-5097

Mailing Address1522 Simpson Dr, Mpb D3230Ann Arbor, MI 48109 · (734) 647-1774

Phone(734) 539-5080

Sole ProprietorNo

Enumeration DateMay 17, 2023

NPPES CertifiedMay 4, 2023

✔ NPI 1508557968 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

License✔ Licensed in MI · 5151016046

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1051 N CANTON CENTER RD, Canton, MI 48187

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kelly Jeane Haidar Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GENEVIEVE ALLEN MD