Healthcare Provider Details

I. General information

NPI: 1467616433
Provider Name (Legal Business Name): MARROUF AZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 METROPOLITAN PKWY
STERLING HEIGHTS MI
48310-4005
US

IV. Provider business mailing address

5280 METRO PKWY
STERLING HEIGHTS MI
48310-4005
US

V. Phone/Fax

Practice location:
  • Phone: 248-290-3111
  • Fax: 586-772-5289
Mailing address:
  • Phone: 248-290-3111
  • Fax: 586-772-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301091976
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: