Provider Demographics
NPI:1902836828
Name:AJLUNI, ERNEST (DPM)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:AJLUNI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17870 FARMINGTON ROAD
Mailing Address - Street 2:BLDG C
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152
Mailing Address - Country:US
Mailing Address - Phone:734-522-7070
Mailing Address - Fax:734-522-2629
Practice Address - Street 1:17870 FARMINGTON ROAD
Practice Address - Street 2:BLDG C
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-522-7070
Practice Address - Fax:734-522-2629
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEA000584213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC4953OtherMCARE
MIP45181OtherBLUE CROSS BLUE SHIELD
MIT34384Medicare UPIN
MIC4953OtherMCARE