Basic Information
Provider Information | |||||||||
NPI: | 1801969969 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JAFRI | ||||||||
FirstName: | SYED ABBAS | ||||||||
MiddleName: | H. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | HENRY FORD HEALTH SYSTEM | ||||||||
Address2: | 14500 HALL ROAD | ||||||||
City: | STERLING HEIGHTS | ||||||||
State: | MI | ||||||||
PostalCode: | 48313 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5862472700 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | HENRY FORD HEALTH SYSTEM | ||||||||
Address2: | 14500 HALL ROAD | ||||||||
City: | STERLING HEIGHTS | ||||||||
State: | MI | ||||||||
PostalCode: | 48313 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5862472940 | ||||||||
FaxNumber: | 5862473733 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/16/2006 | ||||||||
LastUpdateDate: | 05/03/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301057405 | MI | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 273670810 | 05 | MI |   | MEDICAID | SJ057405 | 01 |   | COMMERCIAL-COMMERCIAL NUMBER | OTHER | SJ057405 | 01 |   | CHAMPUS-CHAMPUS | OTHER | 0H26222378 | 01 |   | MEDICARE ID | OTHER | 700H262220 | 01 |   | BLUE CROSS-BLUE CROSS | OTHER |