Provider Demographics
NPI:1780613919
Name:GHIATH TAYEB MD PC
Entity type:Organization
Organization Name:GHIATH TAYEB MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHIATH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-651-0800
Mailing Address - Street 1:1555 SOUTH BLVD E
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5663
Mailing Address - Country:US
Mailing Address - Phone:248-651-0800
Mailing Address - Fax:248-651-7341
Practice Address - Street 1:1555 SOUTH BLVD E
Practice Address - Street 2:SUITE 320
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5663
Practice Address - Country:US
Practice Address - Phone:248-651-0800
Practice Address - Fax:248-651-0800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GHIATH TAYEB MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-01
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067088207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3290970Medicaid
MI0P35730Medicare PIN
MI3290970Medicaid