Individual
GHASSAN DALATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 E BRUNSON ST STE 110, ENTERPRISE, AL 36330-2500
(334) 348-4278
(334) 348-8883
Mailing address
101 E BRUNSON ST STE 110, ENTERPRISE, AL 36330-2500
(334) 348-4278
(334) 348-8883
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
39041
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000547852
BCBS
KY
05
—
3810014609
—
WV
05
—
64098650
—
KY
01
—
P00431665
RAILROAD
KY
Enumeration date
09/13/2006
Last updated
10/19/2020
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