MEDICARE: FATIMA BAYDOUN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	4704363333	MI
2	251B00000X	Case Management Agency	4704362333	MI

General Provider Information

NPI Number	:	1033875661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATIMA BAYDOUN

Provider Business Mailing Address
First Line	:	PO BOX 701393
Second Line	:
City	:	PLYMOUTH
State	:	MI
Zip	:	48170-0964
Country	:	US
Telephone Number	:	313-670-0741
Fax Number	:	313-800-7081

Provider Business Practice Location Address
First Line	:	15538 MICHIGAN AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2901
Country	:	US
Telephone Number	:	877-932-3862
Fax Number	:	313-800-7081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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Directions to “ FATIMA BAYDOUN ” Practice Location

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