Healthcare Provider Details

I. General information

NPI: 1558291609
Provider Name (Legal Business Name): AHMAYA PURTY HARVEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 S OLD WOODWARD AVE STE 200
BIRMINGHAM MI
48009-6721
US

IV. Provider business mailing address

330 LAKE SHORE DR
PONTIAC MI
48341-1087
US

V. Phone/Fax

Practice location:
  • Phone: 248-537-2639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5601012904
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: