Healthcare Provider Details

I. General information

NPI: 1588161400
Provider Name (Legal Business Name): WALEED H AYESH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N MAIN ST STE 2A
HARRISON AR
72601-2911
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST STE 2E
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 870-414-4599
  • Fax:
Mailing address:
  • Phone: 313-745-4832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023050589
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-14601
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: