Provider Demographics
NPI:1942459805
Name:KIDNEY SPECIALISTS OF MICHIGAN
Entity Type:Organization
Organization Name:KIDNEY SPECIALISTS OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-354-3236
Mailing Address - Street 1:29829 TELEGRAPH RD
Mailing Address - Street 2:STE 202
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1330
Mailing Address - Country:US
Mailing Address - Phone:248-354-3236
Mailing Address - Fax:248-208-9417
Practice Address - Street 1:29829 TELEGRAPH RD
Practice Address - Street 2:STE 202
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1330
Practice Address - Country:US
Practice Address - Phone:248-354-3236
Practice Address - Fax:248-208-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P63060Medicare PIN