Basic Information
| Provider Information | |||||||||
| NPI: | 1083950661 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYEWAH | ||||||||
| FirstName: | EBAZARE | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1193 NORTON AVE STE A | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442039526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308251152 | ||||||||
| FaxNumber: | 3308540829 | ||||||||
| Practice Location | |||||||||
| Address1: | 4201 SAINT ANTOINE ST | ||||||||
| Address2: | MC H088, 17033 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137455146 | ||||||||
| FaxNumber: | 3139660880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2012 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301105347 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 35.143190 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.