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General NPI Number Information
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NPI Number | 1174585251
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Entity Type | Individual
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Provider Name | PADMA AYSOLA MD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 19930 FARMINGTON RD STE C
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City | LIVONIA
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State | MI
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Zip | 48152-1440
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Country | US
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Telephone | 248-474-9866
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Fax | 248-474-9867
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Provider Business Mailing Address
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Address Line | 30129 DEER RUN
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-6010
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Country | US
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Telephone | 248-474-9866
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Fax | 248-474-9867
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA038608
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License Number State | MI
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