Healthcare Provider Details

I. General information

NPI: 1699744185
Provider Name (Legal Business Name): ALIRAZA JAFFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 E MAPLE RD STE 290
TROY MI
48083-1135
US

IV. Provider business mailing address

5070 BROOKDALE RD
BLOOMFIELD HILLS MI
48304-3610
US

V. Phone/Fax

Practice location:
  • Phone: 248-749-6630
  • Fax: 888-248-6777
Mailing address:
  • Phone: 248-749-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301065963
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number4301065963
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301065963
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: