Provider Demographics
NPI:1457703597
Name:ATEYAH, GHASSAN (DPM)
Entity type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:
Last Name:ATEYAH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 E BIG BEAVER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2067
Mailing Address - Country:US
Mailing Address - Phone:586-434-3444
Mailing Address - Fax:586-434-3445
Practice Address - Street 1:1607 E BIG BEAVER RD STE 110
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2067
Practice Address - Country:US
Practice Address - Phone:586-434-3444
Practice Address - Fax:586-434-3445
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002654213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-0264Medicaid
MI23-0264Medicaid