Provider Demographics
NPI:1760605166
Name:JAZRAWI, AYAD SHAWKAT (MD)
Entity Type:Individual
Prefix:DR
First Name:AYAD
Middle Name:SHAWKAT
Last Name:JAZRAWI
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 1:710 N CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1399
Mailing Address - Country:US
Mailing Address - Phone:248-288-1117
Mailing Address - Fax:248-288-1107
Practice Address - Street 1:1380 COOLIDGE HWY
Practice Address - Street 2:SUITE250
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7069
Practice Address - Country:US
Practice Address - Phone:248-288-1117
Practice Address - Fax:248-288-1107
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084367207R00000X, 207RC0000X, 2085U0001X, 207UN0901X, 2085R0202X, 2086S0129X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-623-459-5OtherECFMG
MI1760605166Medicaid
MIMI7363001Medicare PIN