Provider Demographics
NPI:1699845578
Name:KAFRI, HUSAM (MD)
Entity Type:Individual
Prefix:
First Name:HUSAM
Middle Name:
Last Name:KAFRI
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 1:200 ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6323
Mailing Address - Country:US
Mailing Address - Phone:248-433-8888
Mailing Address - Fax:248-433-8151
Practice Address - Street 1:200 ELM ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6323
Practice Address - Country:US
Practice Address - Phone:248-433-8888
Practice Address - Fax:248-433-8151
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4560256Medicaid
ON81O2OMedicare ID - Type Unspecified
MI4560256Medicaid