Provider Demographics
NPI:1134977911
Name:ICON ANTI-AGING AND AESTHETICS PLLC
Entity type:Organization
Organization Name:ICON ANTI-AGING AND AESTHETICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-436-4002
Mailing Address - Street 1:555 S OLD WOODWARD AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6607
Mailing Address - Country:US
Mailing Address - Phone:248-436-4002
Mailing Address - Fax:
Practice Address - Street 1:555 S OLD WOODWARD AVE STE 700
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6607
Practice Address - Country:US
Practice Address - Phone:248-821-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service