Provider Demographics
NPI:1578554697
Name:ATALLAH, STEVE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:ATALLAH
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 1:8550 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?:Yes
Enumeration Date:2005-10-31
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301044116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4128640Medicaid
MI4128640Medicaid
M78730002Medicare ID - Type Unspecified