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General NPI Number Information
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NPI Number | 1306472188
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Entity Type | Individual
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Provider Name | CONNOR HAYDEN RAY
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Gender | Male
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 21510 HARRINGTON ST STE 301
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-2378
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Country | US
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Telephone | 586-464-3661
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Fax | 586-649-7735
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Provider Business Mailing Address
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Address Line | 29992 NORTHWESTERN HWY STE C
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-3292
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Country | US
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Telephone |
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 4301513096
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License Number State | MI
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