Provider Demographics
NPI:1801866470
Name:AYUB, HAFIZ M (MD)
Entity Type:Individual
Prefix:
First Name:HAFIZ
Middle Name:M
Last Name:AYUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1153 E MAIN ST
Mailing Address - Street 2:PO BOX 2563
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4056
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:7901 DILEY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9612
Practice Address - Country:US
Practice Address - Phone:614-829-6138
Practice Address - Fax:614-829-6167
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35072011207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5619197341A42OtherBLUECROSS BLUESHIELD
OH2018524Medicaid
OH5619197341A42OtherBLUECROSS BLUESHIELD
OH5619197341A42OtherBLUECROSS BLUESHIELD