Basic Information
| Provider Information | |||||||||
| NPI: | 1861439358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOUBANI | ||||||||
| FirstName: | AYMAN | ||||||||
| MiddleName: | OMAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1560 E. MAPLE RD. | ||||||||
| Address2: | SUITE 400-CREDENTIALING | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480831135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005276266 | ||||||||
| FaxNumber: | 3135768381 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 JOHN R ST | ||||||||
| Address2: | KARMANOS CANCER CENTER | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005276266 | ||||||||
| FaxNumber: | 3135768381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 06/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301075101 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 4301075101 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 4301075101 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.