Provider Demographics
NPI:1356779391
Name:MICHIGAN PREMIER GERIATRICS PLLC
Entity type:Organization
Organization Name:MICHIGAN PREMIER GERIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FOUAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BATAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-354-0730
Mailing Address - Street 1:29877 TELEGRAPH ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7659
Mailing Address - Country:US
Mailing Address - Phone:248-354-0730
Mailing Address - Fax:248-354-1652
Practice Address - Street 1:29877 TELEGRAPH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7659
Practice Address - Country:US
Practice Address - Phone:248-354-0730
Practice Address - Fax:248-354-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty