Basic Information
| Provider Information | |||||||||
| NPI: | 1447236401 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYEB | ||||||||
| FirstName: | GHIATH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1187 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480991187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486510800 | ||||||||
| FaxNumber: | 2486517341 | ||||||||
| Practice Location | |||||||||
| Address1: | 1555 SOUTH BLVD E | ||||||||
| Address2: | STE 320 | ||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483075605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486510800 | ||||||||
| FaxNumber: | 2486517341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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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 | 207RG0100X | 4301067088 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 3290970 | 05 | MI | MEDICAID | 329097010 | 05 | MI | MEDICAID |