Healthcare Provider Details

I. General information

NPI: 1861127359
Provider Name (Legal Business Name): FNU ROSHAN AFSHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR
DETROIT MI
48235-2624
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST OFC
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-3300
  • Fax:
Mailing address:
  • Phone: 313-745-6047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: