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General NPI Number Information
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NPI Number | 1306368527
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Entity Type | Individual
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Provider Name | DOMINIC ANTONIO ATIYEH MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 909 W MAPLE RD STE 100
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City | CLAWSON
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State | MI
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Zip | 48017-1000
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Country | US
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Telephone | 248-435-2028
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Fax | 833-479-2061
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Provider Business Mailing Address
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Address Line | 909 W MAPLE RD STE 100
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City | CLAWSON
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State | MI
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Zip | 48017-1000
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Country | US
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Telephone | 248-435-2028
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Fax | 833-479-2061
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301113327
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License Number State | MI
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