Provider Demographics
NPI:1346202421
Name:AFTAB, SALMA (MD)
Entity Type:Individual
Prefix:
First Name:SALMA
Middle Name:
Last Name:AFTAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19930 FARMINGTON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1433
Mailing Address - Country:US
Mailing Address - Phone:248-306-0180
Mailing Address - Fax:248-306-0182
Practice Address - Street 1:19930 FARMINGTON RD
Practice Address - Street 2:SUITE C
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1433
Practice Address - Country:US
Practice Address - Phone:248-306-0180
Practice Address - Fax:248-306-0182
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0334172080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103393850Medicaid
MI383368694OtherTAX ID
MIE49522Medicare UPIN