Healthcare Provider Details

I. General information

NPI: 1124589254
Provider Name (Legal Business Name): DR. NASAM ALFRAJI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 HOLLYWOOD RD STE 288
SAINT JOSEPH MI
49085-9151
US

IV. Provider business mailing address

3950 HOLLYWOOD RD STE 288
SAINT JOSEPH MI
49085-9151
US

V. Phone/Fax

Practice location:
  • Phone: 269-408-0990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number180009
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301516767
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: