Provider Demographics
NPI:1073675427
Name:AJROUCHE, HUSSEIN HASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSSEIN
Middle Name:HASSAN
Last Name:AJROUCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5728 SCHAEFER RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2298
Mailing Address - Country:US
Mailing Address - Phone:313-581-8080
Mailing Address - Fax:
Practice Address - Street 1:5245 SCHAEFER RD
Practice Address - Street 2:SUITE D
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3257
Practice Address - Country:US
Practice Address - Phone:313-581-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083964207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI70-0-F32947-0OtherBCBS CPIN #
MI5177120-10Medicaid
MIP28070098Medicare PIN