Provider Demographics
NPI:1093379265
Name:ALTAIE, NEHAL (MD)
Entity Type:Individual
Prefix:
First Name:NEHAL
Middle Name:
Last Name:ALTAIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5625 WATER TOWER PL STE 210
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2674
Mailing Address - Country:US
Mailing Address - Phone:248-625-1011
Mailing Address - Fax:
Practice Address - Street 1:5625 WATER TOWER PL STE 210
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2674
Practice Address - Country:US
Practice Address - Phone:248-625-1011
Practice Address - Fax:248-625-0226
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301507939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine