Provider Demographics
NPI:1083950661
Name:AYEWAH, EBAZARE MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:EBAZARE
Middle Name:MARIA
Last Name:AYEWAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1193 NORTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-9526
Mailing Address - Country:US
Mailing Address - Phone:330-825-1152
Mailing Address - Fax:330-854-0829
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:MC H088, 17033
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-5146
Practice Address - Fax:313-966-0880
Is Sole Proprietor?:No
Enumeration Date:2012-12-30
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301105347207Q00000X
390200000X
OH35.143190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program