Provider Demographics
NPI:1649429853
Name:SRIVASTAVA, AJAY KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:AJAY
Middle Name:KUMAR
Last Name:SRIVASTAVA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4466 W BRISTOL RD
Mailing Address - Street 2:FAMILY ORTHOPEDIC ASSOCIATES
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3170
Mailing Address - Country:US
Mailing Address - Phone:810-733-1200
Mailing Address - Fax:810-733-0688
Practice Address - Street 1:4466 W BRISTOL RD
Practice Address - Street 2:FAMILY ORTHOPEDIC ASSOCIATES
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3170
Practice Address - Country:US
Practice Address - Phone:810-733-1200
Practice Address - Fax:810-733-3130
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2013-12-17
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Provider Licenses
StateLicense IDTaxonomies
MI4301086367207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION45090OtherGRP MEDICARE PTAN
MI1649429853Medicaid
MI1649429853Medicaid