Provider Demographics
NPI:1427148063
Name:AOUN, IMAD Y
Entity type:Individual
Prefix:
First Name:IMAD
Middle Name:Y
Last Name:AOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4212
Mailing Address - Country:US
Mailing Address - Phone:313-730-8847
Mailing Address - Fax:313-331-2001
Practice Address - Street 1:8415 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2721
Practice Address - Country:US
Practice Address - Phone:313-331-2000
Practice Address - Fax:313-331-2001
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2365030Medicaid