Healthcare Provider Details

I. General information

NPI: 1538093570
Provider Name (Legal Business Name): EVIAN DAOUD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43200 DEQUINDRE RD STE 105
STERLING HEIGHTS MI
48314-1707
US

IV. Provider business mailing address

57300 DECORA PARK BLVD
NEW HAVEN MI
48048-2987
US

V. Phone/Fax

Practice location:
  • Phone: 248-780-9490
  • Fax:
Mailing address:
  • Phone: 248-780-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013971
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: