Provider Demographics
NPI:1679525216
Name:HATEM, GHALEB F (MD)
Entity Type:Individual
Prefix:DR
First Name:GHALEB
Middle Name:F
Last Name:HATEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4655 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-1936
Mailing Address - Country:US
Mailing Address - Phone:313-295-2888
Mailing Address - Fax:313-295-7923
Practice Address - Street 1:4655 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-1936
Practice Address - Country:US
Practice Address - Phone:313-295-2888
Practice Address - Fax:313-295-7923
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301040489207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1400778Medicaid
MI0821780Medicare PIN
MIA78312Medicare UPIN