Provider Demographics
NPI:1639151624
Name:AFTAB, AFTAB A (MD)
Entity Type:Individual
Prefix:
First Name:AFTAB
Middle Name:A
Last Name:AFTAB
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 1:10118 N CLIO RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1943
Mailing Address - Country:US
Mailing Address - Phone:810-686-5635
Mailing Address - Fax:810-686-0988
Practice Address - Street 1:10118 N CLIO RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1943
Practice Address - Country:US
Practice Address - Phone:810-686-5635
Practice Address - Fax:810-686-0988
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAA0325322080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3048661Medicaid