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General NPI Number Information
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NPI Number | 1467397844
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Entity Type | Organization
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Legal Business Name | PFA PAIN & REHAB MEDICINE PLLC
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Dates
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Enumeration Date | 04/21/2026
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 27270 EVERGREEN RD
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-3249
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Country | US
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Telephone | 734-812-0429
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Fax |
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Provider Business Mailing Address
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Address Line | 27270 EVERGREEN RD
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-3249
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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 | OWNER / PHYSICIAN
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Name | PAYAUM FOTOVAT-AHMADI
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Credential | MD
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Telephone | 734-812-0429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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