Provider Demographics
NPI:1447236401
Name:TAYEB, GHIATH (MD)
Entity Type:Individual
Prefix:DR
First Name:GHIATH
Middle Name:
Last Name:TAYEB
Suffix:
Gender:M
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:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1187
Mailing Address - Country:US
Mailing Address - Phone:248-651-0800
Mailing Address - Fax:248-651-7341
Practice Address - Street 1:1555 SOUTH BLVD E
Practice Address - Street 2:STE 320
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5605
Practice Address - Country:US
Practice Address - Phone:248-651-0800
Practice Address - Fax:248-651-7341
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067088207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3290970Medicaid
MI329097010Medicaid
F15576Medicare UPIN
MI329097010Medicaid
0P35730Medicare PIN