Healthcare Provider Details

I. General information

NPI: 1457185142
Provider Name (Legal Business Name): ASMAU AYUB LCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11521 JOSEPH CAMPAU ST
HAMTRAMCK MI
48212-3050
US

IV. Provider business mailing address

11521 JOSEPH CAMPAU ST
HAMTRAMCK MI
48212-3050
US

V. Phone/Fax

Practice location:
  • Phone: 313-733-4256
  • Fax: 313-733-4256
Mailing address:
  • Phone: 313-733-4265
  • Fax: 313-733-4265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: