Healthcare Provider Details

I. General information

NPI: 1255696605
Provider Name (Legal Business Name): AFTAB HASSAN JAFRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 E LAKE SHORE DR APT 1084
DECATUR IL
62521-3809
US

IV. Provider business mailing address

1730 E LAKE SHORE DR APT 1084
DECATUR IL
62521-3809
US

V. Phone/Fax

Practice location:
  • Phone: 217-329-1000
  • Fax:
Mailing address:
  • Phone: 217-329-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301097533
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: