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General NPI Number Information
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NPI Number | 1205043254
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Entity Type | Individual
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Provider Name | RANDY PAUL AYRES MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 10535 FARMINGTON ROAD SUITE #C
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City | LIVONIA
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State | MI
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Zip | 48150
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Country | US
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Telephone | 734-427-0700
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Fax | 734-427-0733
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Provider Business Mailing Address
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Address Line | 10535 FARMINGTON ROAD SUITE #C
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City | LIVONIA
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State | MI
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Zip | 48150
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Country | US
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Telephone | 734-427-0700
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Fax | 734-427-0733
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301009460
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301086223
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 50357
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A101173
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301086223
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 25304
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License Number State | CA
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