Healthcare Provider Details

I. General information

NPI: 1508406497
Provider Name (Legal Business Name): HAMED P KAFIFAR PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 NORTHFIELD DR
ROCHESTER HILLS MI
48309-3819
US

IV. Provider business mailing address

5576 WHITE HALL CIR
WEST BLOOMFIELD MI
48323-3465
US

V. Phone/Fax

Practice location:
  • Phone: 248-293-2400
  • Fax: 248-293-2440
Mailing address:
  • Phone: 248-613-9751
  • Fax: 248-865-9438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5501005345
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: