Healthcare Provider Details

I. General information

NPI: 1770028284
Provider Name (Legal Business Name): SALIM A JAFFER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4136 LEGACY PKWY SUITE 100
LANSING MI
48911-4265
US

IV. Provider business mailing address

4136 LEGACY PKWY SUITE 100
LANSING MI
48911-4265
US

V. Phone/Fax

Practice location:
  • Phone: 517-999-5300
  • Fax:
Mailing address:
  • Phone: 517-999-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301062463
License Number StateMI

VIII. Authorized Official

Name: SALIM JAFFER
Title or Position: OWNER
Credential: M.D.
Phone: 517-999-5300