Individual
PAYAUM FOTOVAT-AHMADI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
27270 EVERGREEN RD, LATHRUP VILLAGE, MI 48076-3249
(734) 812-0429
Mailing address
27270 EVERGREEN RD, LATHRUP VILLAGE, MI 48076-3249
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301512877
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F313676025878
LICENSE NUMBER
MI
Enumeration date
06/28/2023
Last updated
11/05/2024
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