Provider Demographics
NPI:1851041255
Name:AFIFI, BOTHAINA M (MD)
Entity Type:Individual
Prefix:
First Name:BOTHAINA
Middle Name:M
Last Name:AFIFI
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 1:1100 REID PARKWAY L
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1905
Mailing Address - Country:US
Mailing Address - Phone:346-370-0860
Mailing Address - Fax:
Practice Address - Street 1:1100 REID PARKWAY L
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1905
Practice Address - Country:US
Practice Address - Phone:346-370-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INNA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine