Healthcare Provider Details

I. General information

NPI: 1710680236
Provider Name (Legal Business Name): MAHDI AJROUCHE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 STRINGTOWN RD STE 300
GROVE CITY OH
43123-3993
US

IV. Provider business mailing address

7105 ALLEN RD
ALLEN PARK MI
48101-2009
US

V. Phone/Fax

Practice location:
  • Phone: 614-544-0101
  • Fax: 614-544-0176
Mailing address:
  • Phone: 313-522-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101029478
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: