Provider Demographics
NPI:1699971713
Name:CALVO AYALA, ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:CALVO AYALA
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 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3535 W 13 MILE RD STE 344
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-0497
Practice Address - Fax:248-551-4556
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089825207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10116392OtherOPTIMA HEALTH
VAPAROtherUSA MANAGED CARE
VA-029OtherTRICARE/CHAMPUS
VAPAROtherCORVEL
VAPAROtherCIGNA
VA1699971713OtherUNITED HEALTHCARE
VAPAROtherMULTIPLAN
VA1699971713OtherVIRGINIA PREMIER HEALTH PLAN
VA1699971713OtherCOVENTRY NETWORK
VA495836OtherANTHEM BC/BS
VA1699971713Medicaid
VAPAROtherAETNA
NC1699971713Medicaid
VAPAROtherVIRGINIA HEALTH NETWORK
VA1699971713Medicaid
NC1699971713Medicaid