Fadi Antaki, M.D.

Key facts

NPI

1124127048

Entity type

Individual (NPI type 1)

Primary specialty

Gastroenterology Physician 207RG0100X

License

4301075826 (MI)

Practice address

4646 John R St
Detroit, MI 48201-1916

Phone

(313) 576-1000

NPI assigned

Sep 21, 2006

Sex

Male

Sole proprietor

Yes

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• DLP Marquette Physician Practices Inc Obesity Medicine (Internal Medicine) Physician · Marquette, MI · NPI 1487902995
  Medicare reassignment Care Compare group NPD MI
• University Physician Group Internal Medicine Physician · Detroit, MI · NPI 1447299797
  Medicare reassignment Care Compare group NPD INTERNAL MEDICINE · MI
• DLP Marquette Physician Practices Inc Rural Health Clinic/Center · Marquette, MI · NPI 1205635760
  Care Compare group NPD
• University Physician Group Counselor · Detroit, MI · NPI 1447465661
  Care Compare group NPD
• DLP Marquette Physician Practices Inc Rural Health Clinic/Center · Escanaba, MI · NPI 1679372130
  Care Compare group
• DLP Marquette Physician Practices Inc Counselor · Marquette, MI · NPI 1730437245
  Care Compare group

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• DLP Marquette General Hospital LLC General Acute Care Hospital · Marquette, MI · NPI 1568727048
  Care Compare affiliation Hospital
• VHS Harper-Hutzel Hospital Inc General Acute Care Hospital · Detroit, MI · NPI 1427360700
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Gastroenterology

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

DLP Marquette Physician Practices Inc (193 clinicians)
University Physician Group (399 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uphs Marquette DLP Hospital Hospital · Marquette, MI · CCN 230054
• Harper University Hospital Hospital · Detroit, MI · CCN 230104

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: fadi.antaki.1@8233.direct.athenahealth.com
• Direct secure messaging: fadi.antaki.1@19711.direct.athenahealth.com

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 26, 2018.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516924800000",
    "number": "1124127048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 W COLLEGE AVE",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552736",
            "telephone_number": "906-225-7188",
            "fax_number": "906-225-7783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 JOHN R ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011916",
            "telephone_number": "313-576-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTAKI",
        "first_name": "FADI",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2018-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MA",
            "license": "228347",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "4301075826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Detroit, MI · Gastroenterology Physician in Michigan