Healthcare Provider Details

I. General information

NPI: 1205043254
Provider Name (Legal Business Name): RANDY PAUL AYRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 FARMINGTON ROAD SUITE #C
LIVONIA MI
48150
US

IV. Provider business mailing address

10535 FARMINGTON ROAD SUITE #C
LIVONIA MI
48150
US

V. Phone/Fax

Practice location:
  • Phone: 734-427-0700
  • Fax: 734-427-0733
Mailing address:
  • Phone: 734-427-0700
  • Fax: 734-427-0733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009460
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301086223
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number50357
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA101173
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301086223
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number25304
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: