Healthcare Provider Details

I. General information

NPI: 1467765503
Provider Name (Legal Business Name): AYA OMAR SAEB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21540 W 11 MILE RD STE 200
SOUTHFIELD MI
48076-3843
US

IV. Provider business mailing address

41472 GLADE RD
CANTON MI
48187-3770
US

V. Phone/Fax

Practice location:
  • Phone: 630-935-3862
  • Fax:
Mailing address:
  • Phone: 630-935-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301096412
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAS3062508-51
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301096412
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: