MEDICARE: MAYA ASHKENAZI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301070722	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376523233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA ASHKENAZI MD

Provider Business Mailing Address
First Line	:	23003 GREATER MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-1965
Country	:	US
Telephone Number	:	586-779-6830
Fax Number	:	586-771-1603

Provider Business Practice Location Address
First Line	:	23003 GREATER MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-1965
Country	:	US
Telephone Number	:	586-779-6830
Fax Number	:	586-771-1603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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