Healthcare Provider Details

I. General information

NPI: 1669663068
Provider Name (Legal Business Name): MELISSA AYOUB HEINEN D.O., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 W ANN ARBOR TRL SUITE 210
PLYMOUTH MI
48170-6204
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR PO BOX 0446, LOBBY J
ANN ARBOR MI
48106-0446
US

V. Phone/Fax

Practice location:
  • Phone: 734-455-4600
  • Fax:
Mailing address:
  • Phone: 734-327-0872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101015970
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: