Provider Demographics
NPI:1609919323
Name:BATAYNEH, MOHAMMAD KHALAF (MD,)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:KHALAF
Last Name:BATAYNEH
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:MOHAMMAD
Other - Middle Name:KHALAF
Other - Last Name:ELBATAYNEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:32472 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4309
Mailing Address - Country:US
Mailing Address - Phone:734-425-7150
Mailing Address - Fax:734-425-7151
Practice Address - Street 1:32472 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4309
Practice Address - Country:US
Practice Address - Phone:734-425-7150
Practice Address - Fax:734-425-7151
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4103033756207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0825111Medicare PIN