Healthcare Provider Details

I. General information

NPI: 1013902691
Provider Name (Legal Business Name): AYAD M. AL-KATIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19229 MACK AVE SUITE 34
GROSSE POINTE WOODS MI
48236-2858
US

IV. Provider business mailing address

19229 MACK AVE SUITE 34
GROSSE POINTE WOODS MI
48236-2858
US

V. Phone/Fax

Practice location:
  • Phone: 313-647-3245
  • Fax: 313-647-3244
Mailing address:
  • Phone: 313-647-3245
  • Fax: 313-647-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301049200
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: