Provider Demographics
NPI:1831946151
Name:AYAZ, KANWAL (MD)
Entity type:Individual
Prefix:
First Name:KANWAL
Middle Name:
Last Name:AYAZ
Suffix:
Gender:F
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:MACOMB ACADEMIC CLINIC IM
Mailing Address - Street 2:11885 E. 12 MILE RD., STE 200 B
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-1294
Mailing Address - Country:US
Mailing Address - Phone:586-582-6630
Mailing Address - Fax:
Practice Address - Street 1:MACOMB ACADEMIC CLINIC IM
Practice Address - Street 2:11885 E. 12 MILE RD., STE 200B
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-582-6630
Practice Address - Fax:586-582-6631
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program