Provider Demographics
NPI:1639918741
Name:AFZAL, FATIMA (MD)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:AFZAL
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 1:200 JEFFERSON AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-685-4615
Mailing Address - Fax:616-685-3033
Practice Address - Street 1:300 LAFAYETTE AVE
Practice Address - Street 2:SUITE 3000
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-685-6919
Practice Address - Fax:616-685-3063
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351052945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine