Provider Demographics
NPI:1285618983
Name:BATAH, FOUAD (MD)
Entity type:Individual
Prefix:DR
First Name:FOUAD
Middle Name:
Last Name:BATAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:29877 TELEGRAPH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7659
Mailing Address - Country:US
Mailing Address - Phone:248-354-0730
Mailing Address - Fax:248-354-1652
Practice Address - Street 1:29877 TELEGRAPH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7659
Practice Address - Country:US
Practice Address - Phone:248-354-0730
Practice Address - Fax:248-354-1652
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301060202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1285618983Medicaid
MI103243OtherGREAT LAKES HEALTH PLAN
MI0632811OtherBCBS INDVIDUAL
MI700F314390OtherBLUE SHIELD
MIF253OtherM'CARE
MIG14020Medicare UPIN
MI1285618983Medicaid