Provider Demographics
NPI:1437587573
Name:EVIVA MEDICAL PC
Entity Type:Organization
Organization Name:EVIVA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-877-7765
Mailing Address - Street 1:5728 SCHAEFER RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2298
Mailing Address - Country:US
Mailing Address - Phone:313-624-3011
Mailing Address - Fax:313-846-3901
Practice Address - Street 1:5728 SCHAEFER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2298
Practice Address - Country:US
Practice Address - Phone:313-624-3011
Practice Address - Fax:313-846-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty