Provider Demographics
NPI:1093880403
Name:AVILES, ALBERTO JULIAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:JULIAN
Last Name:AVILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29201 TELEGRAPH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7645
Mailing Address - Country:US
Mailing Address - Phone:248-936-0067
Mailing Address - Fax:248-716-5955
Practice Address - Street 1:29201 TELEGRAPH RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7645
Practice Address - Country:US
Practice Address - Phone:249-936-0067
Practice Address - Fax:248-716-5955
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087507208200000X, 208600000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E012740OtherBCBSM GROUP NUMBER
MI700E012740OtherBCBSM GROUP NUMBER