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General NPI Number Information
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NPI Number | 1518513027
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Entity Type | Organization
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Legal Business Name | AISO PLLC
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 4190 24TH AVE
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3882
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Country | US
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Telephone | 810-216-2882
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Fax |
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Provider Business Mailing Address
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Address Line | 5036 LAKESHORE RD
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3112
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Country | US
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Telephone | 586-872-5916
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | SABBIR AHMED
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Credential | MD
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Telephone | 586-872-5916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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