Provider Demographics
NPI:1578553301
Name:ATTO, GHAZWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GHAZWAN
Middle Name:
Last Name:ATTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GHAZWAN
Other - Middle Name:
Other - Last Name:ATTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2300 BIDDLE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-4650
Mailing Address - Country:US
Mailing Address - Phone:734-246-5705
Mailing Address - Fax:734-246-5750
Practice Address - Street 1:2300 BIDDLE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4650
Practice Address - Country:US
Practice Address - Phone:734-246-5705
Practice Address - Fax:734-246-5750
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGA068489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4431099Medicaid
MI019037OtherMIDWEST MEDICAID
0N33390OtherMEDICARE GROUP
MI135459OtherCARE CHOICES
MI1108280082OtherBCBS
MIH08166OtherHEALTH CHOICE
MIP00001498OtherRAILROAD MEDICARE
0P31250OtherPTAN
MI383577843OtherTAX ID
MIH08166OtherHEALTH CHOICE