Healthcare Provider Details

I. General information

NPI: 1548098239
Provider Name (Legal Business Name): MR. MSEMA MSAFIRI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 ARIES CT
BOWLING GREEN KY
42101-5392
US

IV. Provider business mailing address

579 ARIES CT
BOWLING GREEN KY
42101-5392
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-5985
  • Fax:
Mailing address:
  • Phone: 616-965-5985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: