Basic Information
| Provider Information | |||||||||
| NPI: | 1780613919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GHIATH TAYEB MD PC | ||||||||
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| OtherOrganizationName: | GHIATH TAYEB MD PC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1555 SOUTH BLVD E | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483075663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486510800 | ||||||||
| FaxNumber: | 2486517341 | ||||||||
| Practice Location | |||||||||
| Address1: | 1555 SOUTH BLVD E | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483075663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486510800 | ||||||||
| FaxNumber: | 2486510800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 03/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | TAYEB | ||||||||
| AuthorizedOfficialFirstName: | GHIATH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2486510800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GHIATH TAYEB MD PC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 4301067088 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 3290970 | 05 | MI | MEDICAID |