Provider Demographics
NPI:1285697821
Name:AL-ATTAR, SABAH (MD)
Entity type:Individual
Prefix:DR
First Name:SABAH
Middle Name:
Last Name:AL-ATTAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 PACKARD RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1891
Mailing Address - Country:US
Mailing Address - Phone:734-434-8900
Mailing Address - Fax:734-434-6538
Practice Address - Street 1:2236 PACKARD RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1891
Practice Address - Country:US
Practice Address - Phone:734-434-8900
Practice Address - Fax:734-434-6538
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA060970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381967312OtherTAX ID
MI3045454Medicaid
MI0M69890Medicare ID - Type Unspecified
MI381967312OtherTAX ID