Provider Demographics
NPI:1841207412
Name:AKKAD, AYMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AYMAN
Middle Name:
Last Name:AKKAD
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 1:1331 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2888
Mailing Address - Country:US
Mailing Address - Phone:313-914-5591
Mailing Address - Fax:313-914-5580
Practice Address - Street 1:1331 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2888
Practice Address - Country:US
Practice Address - Phone:313-914-5591
Practice Address - Fax:313-914-5580
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010371732080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4334747Medicaid
MI050564968OtherTAX IDENTIFICATION NUMBER
MA3503306701OtherBCBSM INDIVIDUAL PIN
MIH47928Medicare UPIN
MI050564968OtherTAX IDENTIFICATION NUMBER