Provider Demographics
NPI:1033287560
Name:RABBAIG, SIYADATH S (MD)
Entity Type:Individual
Prefix:
First Name:SIYADATH
Middle Name:S
Last Name:RABBAIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:14300 BECK ROAD
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170
Mailing Address - Country:US
Mailing Address - Phone:734-453-5600
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:14300 BECK ROAD
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170
Practice Address - Country:US
Practice Address - Phone:734-453-5600
Practice Address - Fax:734-354-5960
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI056513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262280OtherBLUE CROSS-BLUE CROSS
SR056513OtherCHAMPUS-CHAMPUS
MI305977210Medicaid
SR056513OtherCOMMERCIAL-COMMERCIAL NUMBER