Provider Demographics
NPI:1558561720
Name:ATTO, GHASSAN AMIR (MD)
Entity Type:Individual
Prefix:
First Name:GHASSAN
Middle Name:AMIR
Last Name:ATTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GHASSAN
Other - Middle Name:AMIR
Other - Last Name:TOBIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14825 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101
Mailing Address - Country:US
Mailing Address - Phone:313-383-7071
Mailing Address - Fax:313-383-7194
Practice Address - Street 1:14825 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2642
Practice Address - Country:US
Practice Address - Phone:313-383-7071
Practice Address - Fax:313-383-7194
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110H239580OtherBC/BS
MI1558561720Medicaid
MI0P31250003Medicare PIN