Provider Demographics
NPI:1114937299
Name:AFD MEDICAL PC
Entity Type:Organization
Organization Name:AFD MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDRICH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-263-0464
Mailing Address - Street 1:15945 19 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1109
Mailing Address - Country:US
Mailing Address - Phone:586-263-0464
Mailing Address - Fax:586-263-0961
Practice Address - Street 1:15945 19 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1109
Practice Address - Country:US
Practice Address - Phone:586-263-0464
Practice Address - Fax:586-263-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035768208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4413690Medicaid
0N86530Medicare ID - Type Unspecified
MI4413690Medicaid