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General NPI Number Information
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NPI Number | 1114937299
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Entity Type | Organization
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Legal Business Name | AFD MEDICAL PC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 15945 19 MILE RD SUITE 100
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City | CLINTON TWP
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State | MI
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Zip | 48038-1109
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Country | US
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Telephone | 586-263-0464
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Fax | 586-263-0961
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Provider Business Mailing Address
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Address Line | 15945 19 MILE RD SUITE 100
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City | CLINTON TWP
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State | MI
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Zip | 48038-1109
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Country | US
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Telephone | 586-263-0464
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Fax | 586-263-0961
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Authorized Official
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Title or Position | OFFICER
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Name | FRIEDRICH DUTKA
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Credential | MD
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Telephone | 586-263-0464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 4301035768
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License Number State | MI
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