MEDICARE: DR. FATIME AYOUB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		MI
2	207V00000X	Obstetrics & Gynecology Physician	4301511306	MI

General Provider Information

NPI Number	:	1669001566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FATIME AYOUB MD

Provider Business Mailing Address
First Line	:	25150 FORD RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3163
Country	:	US
Telephone Number	:	313-277-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	25150 FORD RD STE 200
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3163
Country	:	US
Telephone Number	:	313-277-0400
Fax Number	:	313-277-0300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	09/17/2024

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