Healthcare Provider Details

I. General information

NPI: 1114979515
Provider Name (Legal Business Name): MARIAM AWADA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30603 SOUTHFIELD RD
SOUTHFIELD MI
48076-7729
US

IV. Provider business mailing address

PO BOX 44047
DETROIT MI
48244-0047
US

V. Phone/Fax

Practice location:
  • Phone: 248-540-1900
  • Fax: 248-540-3700
Mailing address:
  • Phone: 248-540-1900
  • Fax: 248-540-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number4301082433
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: