Healthcare Provider Details

I. General information

NPI: 1427678085
Provider Name (Legal Business Name): BAYAN MATARNEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2196
US

IV. Provider business mailing address

3901 BEAUBIEN ST
DETROIT MI
48201-2196
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-1892
  • Fax:
Mailing address:
  • Phone: 313-745-1892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number57.248777
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351049806
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number4301511658
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: