Healthcare Provider Details

I. General information

NPI: 1992266563
Provider Name (Legal Business Name): WOODHAVEN SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18600 VAN HORN ROAD
WOODHAVEN MI
48183-3828
US

IV. Provider business mailing address

18600 VAN HORN ROAD
WOODHAVEN MI
48183-3828
US

V. Phone/Fax

Practice location:
  • Phone: 734-675-0300
  • Fax: 734-676-4954
Mailing address:
  • Phone: 734-675-0300
  • Fax: 734-676-4954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MUHAMMAD JAFFAR
Title or Position: PRESIDENT
Credential: MD
Phone: 734-675-0300