Provider Demographics
NPI:1295099919
Name:BEYDOUN, HUSSEIN (OWNER)
Entity type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:
Last Name:BEYDOUN
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28840 SOUTHFIELD RD STE 240
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2780
Mailing Address - Country:US
Mailing Address - Phone:248-262-7808
Mailing Address - Fax:248-809-2047
Practice Address - Street 1:28840 SOUTHFIELD RD STE 240
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2780
Practice Address - Country:US
Practice Address - Phone:248-262-7808
Practice Address - Fax:248-809-2047
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI364724682332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies