Healthcare Provider Details

I. General information

NPI: 1477106540
Provider Name (Legal Business Name): AYA AL-NOUBANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

3432 SUMMIT DR
BIRMINGHAM AL
35243-5320
US

V. Phone/Fax

Practice location:
  • Phone: 517-515-8567
  • Fax:
Mailing address:
  • Phone: 517-515-8567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.46475
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351045667
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: