Provider Demographics
NPI:1447582234
Name:RESTREPO, AYA (PA)
Entity Type:Individual
Prefix:MS
First Name:AYA
Middle Name:
Last Name:RESTREPO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AYA
Other - Middle Name:IMAD
Other - Last Name:ABU-HAMDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 N LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2729
Mailing Address - Country:US
Mailing Address - Phone:810-629-9200
Mailing Address - Fax:810-629-9653
Practice Address - Street 1:305 N LEROY ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2729
Practice Address - Country:US
Practice Address - Phone:810-629-9200
Practice Address - Fax:810-629-9653
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005647363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H231390OtherBCBSM GROUP NUMBER
MI700H231390OtherBCBSM GROUP NUMBER