Provider Demographics
NPI:1740625524
Name:RAYES, LYDIA JOY (DO)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:JOY
Last Name:RAYES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18303 E 10 MILE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4988
Mailing Address - Country:US
Mailing Address - Phone:586-498-5160
Mailing Address - Fax:586-498-5199
Practice Address - Street 1:18303 E 10 MILE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4988
Practice Address - Country:US
Practice Address - Phone:586-498-5160
Practice Address - Fax:586-498-5199
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101020473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501705OtherBCBS INDIVIDUAL PIN
MI5501705OtherBCBS INDIVIDUAL PIN