Provider Demographics
NPI:1891059077
Name:AL NATOUR, RIAD HASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RIAD
Middle Name:HASSAN
Last Name:AL NATOUR
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 1:5965 PINETREE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1414
Mailing Address - Country:US
Mailing Address - Phone:617-401-5466
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST # SR
Practice Address - Street 2:SURGERY DEPARTMENT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103123207R00000X
MA251620208600000X
IN01082342A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
006037196OtherPASSPORT NUMBER