Bassel Altantawi, MD
Individual provider Active NPI Internal Medicine Physician · Canton, MI
NPI 1497797526 · NPPES record last updated Jun 23, 2010
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Aug 20, 2017.
Key facts
- NPI
- 1497797526
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 4301074111 (MI)
- Practice address
- 610 Pheasant Woods Dr
Canton, MI 48188-3165 - Phone
- (248) 635-7574
- Fax
- (734) 844-3950
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Canton Urgent Care Walk-in Clinic PC | Past |
Accepting new patients | |
| Canton Urgent Care PC | Internal Medicine | Past |
Accepting new patients |
| Bassel Altantawi MD PC | Internal Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301074111 | MI | Yes |
Addresses
Primary practice location
610 Pheasant Woods Dr
Canton, MI 48188-3165
Mailing address
610 Pheasant Woods Dr
Canton, MI 48188-3165
Phone (248) 635-7574
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00254230 | Other | MI | RR MEDICARE |
| 104749090 | Medicaid | MI |
Other providers in Canton, MI
- Mahmoud Mohammad Alrfifeh
- Karam Alrousan
- Ali Alsaden
- Razan Alshuwayhat
- Wafa Altamam
- Kelly Alter
- Summer Alwakya
- Daniel Chinthaka Amarasinghe
- Hira Amarasinghe
- American Home Care Physicians PLLS
All providers in Canton, MI · Internal Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- OIG LEIE (HHS Office of Inspector General).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.