Provider Demographics
NPI:1073799540
Name:AFTAB A AFTAB MDPC
Entity Type:Organization
Organization Name:AFTAB A AFTAB MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AFTAB
Authorized Official - Middle Name:A
Authorized Official - Last Name:AFTAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-686-7310
Mailing Address - Street 1:10118 N CLIO RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1943
Mailing Address - Country:US
Mailing Address - Phone:810-686-7310
Mailing Address - Fax:810-686-0988
Practice Address - Street 1:10118 N CLIO RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1943
Practice Address - Country:US
Practice Address - Phone:810-686-7310
Practice Address - Fax:810-686-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3048661Medicaid
MI3048661Medicaid