Provider Demographics
NPI:1790788701
Name:MAOLOOD, LAYTH (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:LAYTH
Middle Name:
Last Name:MAOLOOD
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:IDA
Mailing Address - State:MI
Mailing Address - Zip Code:48140-9703
Mailing Address - Country:US
Mailing Address - Phone:888-432-3621
Mailing Address - Fax:866-390-9167
Practice Address - Street 1:3160 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:IDA
Practice Address - State:MI
Practice Address - Zip Code:48140-9703
Practice Address - Country:US
Practice Address - Phone:888-432-3621
Practice Address - Fax:866-390-9167
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078595207R00000X, 208000000X
MI4301068044208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104592616Medicaid
OH2230713Medicaid
OH2230713Medicaid
MI6339180001Medicare NSC
MIN84040001Medicare PIN
MI104592616Medicaid