Provider Demographics
NPI:1275747925
Name:HAFEEZ, IMRAN A (MD)
Entity Type:Individual
Prefix:
First Name:IMRAN
Middle Name:A
Last Name:HAFEEZ
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 1:399 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1936
Mailing Address - Country:US
Mailing Address - Phone:860-284-0220
Mailing Address - Fax:
Practice Address - Street 1:399 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1936
Practice Address - Country:US
Practice Address - Phone:860-284-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0494462080S0010X
MI4301082118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine