Provider Demographics
NPI:1275533986
Name:AJINE, FADI M (MD)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:M
Last Name:AJINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 JOHN SREET
Mailing Address - Street 2:SUITE M030
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-343-3939
Mailing Address - Fax:269-343-3948
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M030
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-343-3939
Practice Address - Fax:269-343-3948
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME015958207RR0500X
MI4301110715207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME312730099Medicaid
MIFA6133211OtherDEA
ME312730099Medicaid
MEMM944801Medicare PIN