Provider Demographics
NPI:1881664829
Name:ATAYA, HATEM M (MD)
Entity Type:Individual
Prefix:
First Name:HATEM
Middle Name:M
Last Name:ATAYA
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 1:611 COURT ST
Mailing Address - Street 2:PO BOX 428
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9390
Mailing Address - Country:US
Mailing Address - Phone:989-345-1000
Mailing Address - Fax:989-345-3163
Practice Address - Street 1:611 COURT ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9390
Practice Address - Country:US
Practice Address - Phone:989-345-1000
Practice Address - Fax:989-345-3163
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4698473Medicaid
MIOF51015OtherBLUE CROSS GROUP
MIM57650036Medicare PIN
H59139Medicare UPIN
MI4698473Medicaid