MEDICARE: M BASSEM HOSEIN DEKELBAB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	4301059462	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750376877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M BASSEM HOSEIN DEKELBAB MD

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:	947-522-1867
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 W 13 MILE RD STE 707
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6770
Country	:	US
Telephone Number	:	248-551-0487
Fax Number	:	248-551-3696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/15/2022

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