Basic Information
| Provider Information | |||||||||
| NPI: | 1902943723 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOUAD BATAH MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29877 TELEGRAPH RD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483540730 | ||||||||
| FaxNumber: | 2483541652 | ||||||||
| Practice Location | |||||||||
| Address1: | 29877 TELEGRAPH RD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483540730 | ||||||||
| FaxNumber: | 2483541652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BATAH | ||||||||
| AuthorizedOfficialFirstName: | FOUAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2483540730 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301060202 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3525145 | 05 | MI | MEDICAID |