Provider Demographics
NPI:1619794369
Name:AESTHETIC THEORY PC
Entity type:Organization
Organization Name:AESTHETIC THEORY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MALAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ALATASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-953-0526
Mailing Address - Street 1:3631 S BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3631 S BALDWIN RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1506
Practice Address - Country:US
Practice Address - Phone:248-499-9106
Practice Address - Fax:248-294-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty