Healthcare Provider Details

I. General information

NPI: 1740976356
Provider Name (Legal Business Name): MOHAMMAD HUSSEIN AYOUB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BIDDLE AVE
WYANDOTTE MI
48192-4668
US

IV. Provider business mailing address

18 WILLIAMSON CT
DEARBORN MI
48126-2126
US

V. Phone/Fax

Practice location:
  • Phone: 734-246-7095
  • Fax:
Mailing address:
  • Phone: 313-979-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0107142
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number4351051357
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: