Healthcare Provider Details

I. General information

NPI: 1063067692
Provider Name (Legal Business Name): MEDICAL PAIN RELIEF CAM CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 FARMINGTON RD
LIVONIA MI
48150-5732
US

IV. Provider business mailing address

10535 FARMINGTON RD
LIVONIA MI
48150-5732
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 TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDY PAUL AYRES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 734-427-0700