Provider Demographics
NPI:1407974801
Name:AWAD, MARIE ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:ELIZABETH
Last Name:AWAD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:47945 MILONAS DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5040
Mailing Address - Country:US
Mailing Address - Phone:586-566-4072
Mailing Address - Fax:586-884-6940
Practice Address - Street 1:47945 MILONAS DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-5040
Practice Address - Country:US
Practice Address - Phone:586-566-4072
Practice Address - Fax:586-884-6940
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010331207Q00000X
CO38910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F05080Medicare UPIN