Organization
BASSEL ALTANTAWI MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BASSEL ALTANTAWI (PHYSICIAN/PRESIDENT)
(248) 635-7574
Entity
Organization
Contact information
Practice address
9150 ALLEN ROAD, ALLEN PARK, MI 48101
(248) 635-7574
Mailing address
610 PHEASENT WOODS DR, CANTON, MI 48188
(248) 635-7574
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
BA074111
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104225970
BCBS
MI
Enumeration date
11/03/2006
Last updated
08/22/2020
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