Organization
HOME DIALYSIS SPECIALTY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FATEN AYYOUB MD (PARTNER)
(248) 642-5038
Entity
Organization
Contact information
Practice address
29001 HARPER AVE, ST CLR SHORES, MI 48081-2711
(248) 642-5038
Mailing address
30100 TELEGRAPH RD, SUITE 200, BINGHAM FARMS, MI 48025-4516
(248) 723-0219
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
D74250
MI
Other
Enumeration date
06/12/2012
Last updated
08/14/2014
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