# BASSEL ALTANTAWI MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417036054
- **Authorized official:** BASSEL ALTANTAWI (PHYSICIAN/PRESIDENT)
- **Authorized official phone:** (248) 635-7574

## Contact information

- **Practice address:** 9150 ALLEN ROAD, ALLEN PARK, MI 48101
- **Practice address phone:** (248) 635-7574
- **Mailing address:** 610 PHEASENT WOODS DR, CANTON, MI 48188
- **Mailing address phone:** (248) 635-7574

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | BA074111 | MI | Yes |

## Other

- **Enumeration date:** 11/03/2006
- **Last updated:** 08/22/2020