MEDICARE: DR. SAIF M FATTEH M.D.

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	207N00000X	MA
2	207N00000X	Dermatology Physician	1014051	MA
3	208000000X	Pediatrics Physician	4301098808	MI
4	207N00000X	Dermatology Physician	4301098808	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07776867	OTHER		USMLE ID

General Provider Information

NPI Number	:	1093001299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAIF M FATTEH M.D.

Provider Business Mailing Address
First Line	:	2843 E GRAND RIVER AVE STE 282
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-6724
Country	:	US
Telephone Number	:	855-472-3300
Fax Number	:	855-472-3300

Provider Business Practice Location Address
First Line	:	2981 HEALTH PKWY
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-9347
Country	:	US
Telephone Number	:	855-472-3300
Fax Number	:	855-472-3300

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

Provider Enumeration Date	:	06/26/2011
Last Update Date	:	04/23/2026

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