MEDICARE: HATEM M ATAYA MD

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	207R00000X	Internal Medicine Physician	4301079461	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	OF51015	OTHER	MI	BLUE CROSS GROUP

General Provider Information

NPI Number	:	1881664829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HATEM M ATAYA MD

Provider Business Mailing Address
First Line	:	611 COURT ST
Second Line	:	PO BOX 428
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9390
Country	:	US
Telephone Number	:	989-345-1000
Fax Number	:	989-345-3163

Provider Business Practice Location Address
First Line	:	611 COURT ST
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9390
Country	:	US
Telephone Number	:	989-345-1000
Fax Number	:	989-345-3163

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	02/28/2008

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