Provider Demographics
NPI:1043387566
Name:JAFFER, SALIM A (MD)
Entity Type:Individual
Prefix:DR
First Name:SALIM
Middle Name:A
Last Name:JAFFER
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 1:4136 LEGACY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4265
Mailing Address - Country:US
Mailing Address - Phone:517-999-5300
Mailing Address - Fax:517-999-5310
Practice Address - Street 1:1615 WINSTED DR STE 2
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4673
Practice Address - Country:US
Practice Address - Phone:574-537-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430162463207RG0100X
IN01083146A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4642226Medicaid
MI4642226Medicaid
0M96040005Medicare ID - Type Unspecified