Healthcare Provider Details

I. General information

NPI: 1659431054
Provider Name (Legal Business Name): PAUL A. EDWARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRY FORD HEALTH SYSTEM ONE FORD PLACE 1F -BEHAVIORAL
DETROIT MI
48202
US

IV. Provider business mailing address

HENRY FORD HEALTH SYSTEM ONE FORD PLACE 1F -BEHAVIORAL
DETROIT MI
48202
US

V. Phone/Fax

Practice location:
  • Phone: 313-876-6677
  • Fax: 313-874-6650
Mailing address:
  • Phone: 313-876-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number054513
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301054513
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: