Individual
BASIL M FATHALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3901 BEAUBIEN ST, CHILDREN'S HOSPITAL OF MI, DETROIT, MI 48201-2119
(215) 427-5094
Mailing address
4201 ST. ANTOINE, UNIVERSITY PEDIATRICIANS UHC 6F MAILBOX# 226, DETROIT, MI 48201-4139
(313) 966-5051
Taxonomy
Speciality
Code
Description
License number
State
2080P0216X
Pediatric Rheumatology Physician
Primary
MD427787
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1014672880001
—
PA
Enumeration date
06/13/2006
Last updated
05/28/2009
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