Provider Demographics
NPI:1174550974
Name:ATTALLA, YASSIR (MD)
Entity type:Individual
Prefix:DR
First Name:YASSIR
Middle Name:
Last Name:ATTALLA
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 1:15450 NORTHLINE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2398
Mailing Address - Country:US
Mailing Address - Phone:734-282-2020
Mailing Address - Fax:734-282-2002
Practice Address - Street 1:15450 NORTHLINE RD STE 102
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2490
Practice Address - Country:US
Practice Address - Phone:734-720-7270
Practice Address - Fax:734-288-0934
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA77367Medicare UPIN
MI0P43510Medicare ID - Type Unspecified