Provider Demographics
NPI:1922038488
Name:ZUGHAIB, MARCEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCEL
Middle Name:E
Last Name:ZUGHAIB
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 1:22250 PROVIDENCE DR.
Mailing Address - Street 2:#705
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-552-9858
Mailing Address - Fax:248-552-9510
Practice Address - Street 1:22250 PROVIDENCE DR.
Practice Address - Street 2:#705
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-552-9858
Practice Address - Fax:248-552-9510
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI062985207RI0011X
MI4301062985207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3147857Medicaid
MI3147857Medicaid
MIE16582Medicare UPIN
MI0M06660002Medicare ID - Type Unspecified
OF360210Medicare PIN