1407351737 NPI number — ELISABETH EKKEL-AYOUB DO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407351737 NPI number — ELISABETH EKKEL-AYOUB DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EKKEL-AYOUB
Provider First Name:
ELISABETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407351737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COMPREHENSIVE BREAST CARE
Provider Second Line Business Mailing Address:
5701 BOW POINTE DR., SUITE 280
Provider Business Mailing Address City Name:
CLARKSTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-922-6635
Provider Business Mailing Address Fax Number:
248-922-6636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COMPREHENSIVE BREAST CARE
Provider Second Line Business Practice Location Address:
4967 CROOKS RD #210
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-687-7300
Provider Business Practice Location Address Fax Number:
248-687-7305
Provider Enumeration Date:
03/28/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086X0206X , with the licence number:  5101027297 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 5101027297 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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