NPIMap

Individual provider Active NPI

Antonious S Attallah, M.D.

  • Interventional Cardiology Physician
  • Roseville, MI
National Provider Identifier
1306081138
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
4301094176 Issued in MI
Practice address
25195 Kelly Road
Suite a
Roseville, MI 48066-4909
Phone
(586) 775-4594
Fax
(586) 775-4506
NPI assigned
Dec 8, 2008
Last updated
Mar 2, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X BP10024918 TX
Internal Medicine Physician 207R00000X 4301094176 MI
Cardiovascular Disease Physician 207RC0000X 4301094176 MI
Interventional Cardiology Physician 207RI0011X 4301094176 MI Primary
Nuclear Cardiology Physician 207UN0901X 4301094176 MI

Addresses

Primary practice location

25195 Kelly Road
Suite a
Roseville, MI 48066-4909

Mailing address

25195 Kelly Road
Suite a
Roseville, MI 48066-4909
Phone (586) 775-4594

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130328000154 MI Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9335384064 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

25195 Kelly Rd
Suite a
Roseville, MI 48066-5084
Phone (586) 775-4594

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting38
Leg revascularization (restoring blood flow)15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
BP10024918TXMDInternal Medicine Physician
4301094176MIMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital CurrentSince Oct 1, 2018 Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients
Henry Ford Semi Medical Group CurrentSince Jun 6, 2017 Accepting new patients
Henry Ford Health System Current Accepting new patients
Henry Ford Semi Medical Group Internal Medicine CurrentSince Jun 6, 2017 Accepting new patients
Henry Ford Health Providence Hospital Cardiovascular Disease CurrentSince Jan 21, 2026 Accepting new patients
Henry Ford Health Providence Hospital CurrentSince Jan 21, 2026 Accepting new patients
Henry Ford Health System Internal Medicine CurrentSince Feb 18, 2013 Accepting new patients
Henry Ford Health St. John Hospital Internal Medicine CurrentSince Oct 1, 2018 Accepting new patients
Henry Ford Semi Medical Group Internal Medicine Current Accepting new patients
Henry Ford Health System CurrentSince Feb 18, 2013 Accepting new patients

Locations

36750 26 Mile Rd
Ste 140
Chesterfield, MI 48047
Phone (313) 343-7110

22720 Michigan Ave
Ste 200
Dearborn, MI 48124
Phone (313) 791-3000

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

22201 Moross Rd
Grosse Pointe Woods, MI 48236
Phone (313) 343-6530

1101 W University Dr
Rochester Hls, MI 48307
Phone (248) 601-4805

25195 Kelly Rd
Ste A
Roseville, MI 48066
Phone (586) 775-4594

37771 Schoenherr Rd
Ste 104
Sterling Hts, MI 48312
Phone (810) 286-0050

28000 Dequindre Rd
Warren, MI 48092
Phone (586) 743-0944

30117 Schoenherr Rd
Ste 400
Warren, MI 48088
Phone (586) 552-4848

Interoperability endpoints

  • Direct secure messaging: aattallah14327@direct.hfhs.org

Organizations & group practices 12

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

Hospital & facility affiliations 7

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1306081138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25195 KELLY ROAD",
            "address_2": "SUITE A",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664909",
            "telephone_number": "586-775-4594",
            "fax_number": "586-775-4506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25195 KELLY ROAD",
            "address_2": "SUITE A",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664909",
            "telephone_number": "586-775-4594",
            "fax_number": "586-775-4506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATTALLAH",
        "first_name": "ANTONIOUS",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-08",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "BP10024918",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301094176",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301094176",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MI",
            "license": "4301094176",
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "MI",
            "license": "4301094176",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

Verify at the official NPI Registry.