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General NPI Number Information
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NPI Number | 1679596688
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Entity Type | Individual
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Provider Name | AERI PAE MD
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 30795 23 MILE RD
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City | CHESTERFIELD
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State | MI
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Zip | 48047-5720
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Country | US
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Telephone | 586-421-3053
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Fax |
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Provider Business Mailing Address
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Address Line | 1733 PEMBROKE RD
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City | BIRMINGHAM
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State | MI
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Zip | 48009-5823
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Country | US
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Telephone | 586-747-7386
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 764542
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License Number State | MI
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