Provider Demographics
NPI:1760166268
Name:AYANDA, GLORY OLUWASEMILORE (MD)
Entity Type:Individual
Prefix:
First Name:GLORY
Middle Name:OLUWASEMILORE
Last Name:AYANDA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:BEAUMONT HOSPITAL- GME OFFICE
Mailing Address - Street 2:3601 W 13 MILE RD
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-898-0413
Mailing Address - Fax:
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-551-3000
Practice Address - Fax:248-551-2032
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-09-20
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Provider Licenses
StateLicense IDTaxonomies
MI4351050861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics