Individual
BASSEL ALTANTAWI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
610 PHEASANT WOODS DR, CANTON, MI 48188-3165
(248) 635-7574
(734) 844-3950
Mailing address
610 PHEASANT WOODS DR, CANTON, MI 48188-3165
(248) 635-7574
(734) 844-3950
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301074111
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104749090
—
MI
01
—
P00254230
RR MEDICARE
MI
Enumeration date
06/12/2006
Last updated
06/23/2010
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