Healthcare Provider Details

I. General information

NPI: 1932551348
Provider Name (Legal Business Name): AYMAN ABULAWI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2016
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST SUITE 510
DETROIT MI
48201-2020
US

IV. Provider business mailing address

4160 JOHN R ST SUITE 510
DETROIT MI
48201-2020
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-7777
  • Fax:
Mailing address:
  • Phone: 313-993-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01087728A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: