Healthcare Provider Details

I. General information

NPI: 1245533967
Provider Name (Legal Business Name): HUSSEIN AJROUCHE, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12740 W WARREN AVE STE 200
DEARBORN MI
48126-4530
US

IV. Provider business mailing address

12740 W WARREN AVE STE 200
DEARBORN MI
48126-4530
US

V. Phone/Fax

Practice location:
  • Phone: 313-291-6694
  • Fax: 313-291-6694
Mailing address:
  • Phone: 313-291-6694
  • Fax: 313-291-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301083964
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301083964
License Number StateMI

VIII. Authorized Official

Name: NANCY MOLNAR
Title or Position: OFFICE MANAGER
Credential:
Phone: 313-291-6694