Basic Information
| Provider Information | |||||||||
| NPI: | 1679557979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAFTAN | ||||||||
| FirstName: | SHELDON | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27483 DEQUINDRE RD | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480713491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485476603 | ||||||||
| FaxNumber: | 2485475696 | ||||||||
| Practice Location | |||||||||
| Address1: | 27483 DEQUINDRE RD | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480713491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485476603 | ||||||||
| FaxNumber: | 2485475696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 02/16/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101004775 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 700H217350 | 01 | MI | BLUE SHIELD | OTHER | 1679557979 | 05 | MI | MEDICAID |