Provider Demographics
NPI:1093001299
Name:FATTEH, SAIF M (MD)
Entity Type:Individual
Prefix:DR
First Name:SAIF
Middle Name:M
Last Name:FATTEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAIF
Other - Middle Name:M
Other - Last Name:FATTEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2843 E GRAND RIVER AVE # 282
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6722
Mailing Address - Country:US
Mailing Address - Phone:855-472-3300
Mailing Address - Fax:855-472-3300
Practice Address - Street 1:5135 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4002
Practice Address - Country:US
Practice Address - Phone:855-472-3300
Practice Address - Fax:855-472-3300
Is Sole Proprietor?:No
Enumeration Date:2011-06-26
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301098808208000000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
07776867OtherUSMLE ID