Provider Demographics
NPI:1013902691
Name:AL-KATIB, AYAD M (MD)
Entity Type:Individual
Prefix:
First Name:AYAD
Middle Name:M
Last Name:AL-KATIB
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 1:19229 MACK AVE
Mailing Address - Street 2:SUITE 34
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2858
Mailing Address - Country:US
Mailing Address - Phone:313-647-3245
Mailing Address - Fax:313-647-3244
Practice Address - Street 1:19229 MACK AVE
Practice Address - Street 2:SUITE 34
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2858
Practice Address - Country:US
Practice Address - Phone:313-647-3245
Practice Address - Fax:313-647-3244
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049200207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4327573Medicaid
MION34020Medicare ID - Type Unspecified
MI4327573Medicaid