Provider Demographics
NPI:1881604007
Name:ATALLAH, PIERRE CHAFIC (MD)
Entity type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:CHAFIC
Last Name:ATALLAH
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:PO BOX 82177
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48308-2177
Mailing Address - Country:US
Mailing Address - Phone:248-651-9200
Mailing Address - Fax:248-651-0355
Practice Address - Street 1:610 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1487
Practice Address - Country:US
Practice Address - Phone:248-651-9200
Practice Address - Fax:248-651-0355
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032954207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE19117Medicare UPIN
MIF34995018Medicare PIN
MIN99730002Medicare PIN