Healthcare Provider Details

I. General information

NPI: 1629045760
Provider Name (Legal Business Name): ALAN MICHAEL AFSARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22151 MOROSS RD SUITE 214
DETROIT MI
48236-2167
US

IV. Provider business mailing address

22151 MOROSS RD SUITE 214
DETROIT MI
48236-2167
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-4867
  • Fax: 313-343-3280
Mailing address:
  • Phone: 313-343-4867
  • Fax: 313-343-3280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301076896
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: