Provider Demographics
NPI:1760844260
Name:AYOUBA, MALIKE (LMT)
Entity Type:Individual
Prefix:
First Name:MALIKE
Middle Name:
Last Name:AYOUBA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6741 S JEFFERY BLVD
Mailing Address - Street 2:1B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-1082
Mailing Address - Country:US
Mailing Address - Phone:773-664-6867
Mailing Address - Fax:773-345-4629
Practice Address - Street 1:1019 MADISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4404
Practice Address - Country:US
Practice Address - Phone:773-373-9451
Practice Address - Fax:773-345-4629
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227018161173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist