Basic Information
| Provider Information | |||||||||
| NPI: | 1528620366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAYYA | ||||||||
| FirstName: | MAHA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9041 EVENTIDE RD | ||||||||
| Address2: | |||||||||
| City: | LIVERPOOL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130901596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2245440051 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 N. EAST AVE | ||||||||
| Address2: | GME - 2ND FLOOR CAB | ||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492011753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172057147 | ||||||||
| FaxNumber: | 5172057050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2019 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4351045292 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 31797501 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.