MEDICARE: MALIKE AYOUBA LMT

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	173C00000X	Reflexologist	227018161	IL
2	225700000X	Massage Therapist	227018161	IL

General Provider Information

NPI Number	:	1760844260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALIKE AYOUBA LMT

Provider Business Mailing Address
First Line	:	6741 S JEFFERY BLVD
Second Line	:	1B
City	:	CHICAGO
State	:	IL
Zip	:	60649-1082
Country	:	US
Telephone Number	:	773-664-6867
Fax Number	:	773-345-4629

Provider Business Practice Location Address
First Line	:	1019 MADISON ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-4404
Country	:	US
Telephone Number	:	773-373-9451
Fax Number	:	773-345-4629

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

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	01/27/2017

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