Provider Demographics
NPI:1306368527
Name:ATIYEH, DOMINIC ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:ANTONIO
Last Name:ATIYEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 W MAPLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1000
Mailing Address - Country:US
Mailing Address - Phone:248-435-2028
Mailing Address - Fax:833-479-2061
Practice Address - Street 1:909 W MAPLE RD STE 100
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1000
Practice Address - Country:US
Practice Address - Phone:248-435-2028
Practice Address - Fax:833-479-2061
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301113327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine