Provider Demographics
NPI:1093361354
Name:AFFINITY HEALTH ADVANTAGE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:AFFINITY HEALTH ADVANTAGE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KINJAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-323-4410
Mailing Address - Street 1:302 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:ARITA
Mailing Address - State:IA
Mailing Address - Zip Code:50020
Mailing Address - Country:US
Mailing Address - Phone:712-249-3661
Mailing Address - Fax:
Practice Address - Street 1:2217 S SHORE CTR # 250
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-8073
Practice Address - Country:US
Practice Address - Phone:510-323-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty