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General NPI Number Information
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NPI Number | 1811633241
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Entity Type | Organization
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Legal Business Name | REQUIEM, LLC
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 543 N MAIN ST STE 211
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City | ROCHESTER
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State | MI
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Zip | 48307-1485
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Country | US
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Telephone | 248-495-2438
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Fax |
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Provider Business Mailing Address
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Address Line | 145 S LIVERNOIS RD # 336
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-1837
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Country | US
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Telephone | 248-495-2438
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | PIERRE CHARBEL ATALLAH
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Credential | MD, MS, MBA
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Telephone | 248-495-2438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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