Healthcare Provider Details

I. General information

NPI: 1467397844
Provider Name (Legal Business Name): PFA PAIN & REHAB MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27270 EVERGREEN RD
LATHRUP VILLAGE MI
48076-3249
US

IV. Provider business mailing address

27270 EVERGREEN RD
LATHRUP VILLAGE MI
48076-3249
US

V. Phone/Fax

Practice location:
  • Phone: 734-812-0429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: PAYAUM FOTOVAT-AHMADI
Title or Position: OWNER / PHYSICIAN
Credential: MD
Phone: 734-812-0429