Organization
REQUIEM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PIERRE CHARBEL ATALLAH MD, MS, MBA (MANAGING MEMBER)
(248) 495-2438
Entity
Organization
Contact information
Practice address
543 N MAIN ST STE 211, ROCHESTER, MI 48307-1485
(248) 495-2438
Mailing address
145 S LIVERNOIS RD # 336, ROCHESTER HILLS, MI 48307-1837
(248) 495-2438
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0931859
BCBS
—
05
—
20150804334789
—
MI
01
—
F34995040
PTAN
—
Enumeration date
05/09/2022
Last updated
05/09/2022
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