Healthcare Provider Details

I. General information

NPI: 1801866470
Provider Name (Legal Business Name): HAFIZ M AYUB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 DILEY RD SUITE 120
CANAL WINCHESTER OH
43110-9612
US

IV. Provider business mailing address

1153 E MAIN ST PO BOX 2563
LANCASTER OH
43130-4056
US

V. Phone/Fax

Practice location:
  • Phone: 614-829-6138
  • Fax: 614-829-6167
Mailing address:
  • Phone: 740-687-8990
  • Fax: 740-687-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35072011
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35072011
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: