Provider Demographics
NPI:1558352955
Name:ATALLAH, ELAINE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:L
Last Name:ATALLAH
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 1:8550 N SILVERY LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4510
Mailing Address - Country:US
Mailing Address - Phone:313-561-2990
Mailing Address - Fax:313-561-7065
Practice Address - Street 1:8550 N SILVERY LN
Practice Address - Street 2:SUITE 200
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4510
Practice Address - Country:US
Practice Address - Phone:313-561-2990
Practice Address - Fax:313-561-7065
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4128650Medicaid
M78730005Medicare ID - Type Unspecified
A76131Medicare UPIN