Provider Demographics
NPI:1457305815
Name:ABROU, AYAD EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:AYAD
Middle Name:EDWARD
Last Name:ABROU
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 1:29355 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1053
Mailing Address - Country:US
Mailing Address - Phone:248-353-0880
Mailing Address - Fax:248-354-8301
Practice Address - Street 1:29355 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1053
Practice Address - Country:US
Practice Address - Phone:248-353-0880
Practice Address - Fax:248-354-8301
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077868207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00335252OtherMEDICARE RAILROAD
I43915Medicare UPIN