Healthcare Provider Details

I. General information

NPI: 1366671174
Provider Name (Legal Business Name): WAYEL T KATRIB M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23000 TELEGRAPH RD STE 1
FLAT ROCK MI
48134-9265
US

IV. Provider business mailing address

23000 TELEGRAPH RD STE 1
FLAT ROCK MI
48134-9265
US

V. Phone/Fax

Practice location:
  • Phone: 734-304-4500
  • Fax: 248-658-1822
Mailing address:
  • Phone: 734-304-4500
  • Fax: 248-658-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5315042359
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: