MEDICARE: MR. ALI MOHAMED AYOUBI NP

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	363LF0000X	Family Nurse Practitioner	F11200892	MI

General Provider Information

NPI Number	:	1710550827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALI MOHAMED AYOUBI NP

Provider Business Mailing Address
First Line	:	19310 OUTER DR
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-1405
Country	:	US
Telephone Number	:	313-622-1157
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 SOUTH BLVD E STE 200
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5359
Country	:	US
Telephone Number	:	248-651-0800
Fax Number	:

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

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	07/19/2021

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