Provider Demographics
NPI:1205043254
Name:AYRES, RANDY PAUL (MD)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:PAUL
Last Name:AYRES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10535 FARMINGTON ROAD
Mailing Address - Street 2:SUITE #C
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150
Mailing Address - Country:US
Mailing Address - Phone:734-427-0700
Mailing Address - Fax:734-427-0733
Practice Address - Street 1:10535 FARMINGTON ROAD
Practice Address - Street 2:SUITE #C
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150
Practice Address - Country:US
Practice Address - Phone:734-427-0700
Practice Address - Fax:734-427-0733
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2022-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI2301009460111N00000X
MI43010862232084P0800X, 208D00000X
WI50357208D00000X
CAA101173208D00000X
CA25304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No111N00000XChiropractic ProvidersChiropractor
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry