Healthcare Provider Details

I. General information

NPI: 1811951064
Provider Name (Legal Business Name): MOHAMMED J ZAFAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 MOORSBRIDGE RD STE 202
PORTAGE MI
49024-7414
US

IV. Provider business mailing address

8120 MOORSBRIDGE RD STE 202
PORTAGE MI
49024-7414
US

V. Phone/Fax

Practice location:
  • Phone: 269-323-0955
  • Fax: 269-323-1279
Mailing address:
  • Phone: 269-323-0955
  • Fax: 269-323-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number4301059523
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301059523
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: