Healthcare Provider Details

I. General information

NPI: 1770409849
Provider Name (Legal Business Name): FIVE LAKES MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11333 JOSEPH CAMPAU ST
HAMTRAMCK MI
48212-3038
US

IV. Provider business mailing address

800 INDIANWOOD RD
LAKE ORION MI
48362-1320
US

V. Phone/Fax

Practice location:
  • Phone: 313-463-0653
  • Fax:
Mailing address:
  • Phone: 313-463-0653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMZY NAJI AIYASH
Title or Position: PHYSICIAN
Credential: MD
Phone: 313-463-0653