Provider Demographics
NPI:1881650760
Name:AYYOUB, FATEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:FATEN
Middle Name:S
Last Name:AYYOUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 HAWTHORNE DR S
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5536
Mailing Address - Country:US
Mailing Address - Phone:586-778-0664
Mailing Address - Fax:586-778-0396
Practice Address - Street 1:29001 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2711
Practice Address - Country:US
Practice Address - Phone:586-778-0664
Practice Address - Fax:586-778-0396
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI073989207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I29431Medicare UPIN
I29431Medicare UPIN