Healthcare Provider Details

I. General information

NPI: 1386681989
Provider Name (Legal Business Name): VICTOR CHRISTOPHER AJLUNI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16836 NEWBURGH RD UPC LIVONIA
LIVONIA MI
48154-1600
US

IV. Provider business mailing address

1560 E MAPLE RD SUITE 400 - CREDENTIALING
TROY MI
48083-1138
US

V. Phone/Fax

Practice location:
  • Phone: 888-362-7792
  • Fax: 734-464-5885
Mailing address:
  • Phone: 734-464-4220
  • Fax: 734-464-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301064013
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: