Provider Demographics
NPI:1174084941
Name:MROUE, GHALEB
Entity type:Individual
Prefix:
First Name:GHALEB
Middle Name:
Last Name:MROUE
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 1:25354 EVERGREEN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1776
Mailing Address - Country:US
Mailing Address - Phone:313-377-2400
Mailing Address - Fax:248-809-6865
Practice Address - Street 1:6436 STEADMAN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2057
Practice Address - Country:US
Practice Address - Phone:313-377-2400
Practice Address - Fax:248-809-6865
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI802300418OtherMEDICAL EQUIMENT