Healthcare Provider Details

I. General information

NPI: 1912195835
Provider Name (Legal Business Name): KAMRAN S JAFRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2454 MONROE ST STE A
DEARBORN MI
48124-3038
US

IV. Provider business mailing address

598 CANTERBURY RD
GROSSE POINTE WOODS MI
48236-1200
US

V. Phone/Fax

Practice location:
  • Phone: 313-562-4100
  • Fax:
Mailing address:
  • Phone: 646-262-3135
  • Fax: 646-626-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number220892
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number4301072754
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: