Individual
AERI PAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
30795 23 MILE RD, CHESTERFIELD, MI 48047-5720
(586) 421-3053
Mailing address
1733 PEMBROKE RD, BIRMINGHAM, MI 48009-5823
(586) 747-7386
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
764542
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
372341100
—
MI
Enumeration date
07/25/2006
Last updated
09/16/2010
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