Healthcare Provider Details

I. General information

NPI: 1750363453
Provider Name (Legal Business Name): KHALID ZAFAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 12 MILE RD STE 250
BERKLEY MI
48072-2182
US

IV. Provider business mailing address

29829 TELEGRAPH RD STE 202
SOUTHFIELD MI
48034-7656
US

V. Phone/Fax

Practice location:
  • Phone: 248-414-3210
  • Fax: 248-646-7854
Mailing address:
  • Phone: 248-414-3210
  • Fax: 248-646-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301064963
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: