Healthcare Provider Details

I. General information

NPI: 1295645968
Provider Name (Legal Business Name): ALIA PEDIATRIC NEUROLOGY & EPILEPSY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 WILDBERRY DR
LOWELL MI
49331-8972
US

IV. Provider business mailing address

2770 WILDBERRY DR
LOWELL MI
49331-8972
US

V. Phone/Fax

Practice location:
  • Phone: 833-463-8761
  • Fax: 616-226-4837
Mailing address:
  • Phone: 833-463-8761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANASTASIA LUNIOVA
Title or Position: OWNER
Credential: MD
Phone: 718-915-3788