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General NPI Number Information
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NPI Number | 1588161400
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Entity Type | Individual
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Provider Name | WALEED H AYESH MD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2018
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 620 N MAIN ST STE 2A
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City | HARRISON
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State | AR
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Zip | 72601-2911
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Country | US
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Telephone | 870-414-4599
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 SAINT ANTOINE ST STE 2E
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-745-4832
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2023050589
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-14601
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License Number State | AR
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