=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790983443
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OSMAN ABDULKADIR AHMEDFIQI M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2007
-----------------------------------------------------
Last Update Date | 05/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 N PATTERSON RD
-----------------------------------------------------
City | REED CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49677-8041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-486-6790
-----------------------------------------------------
Fax | 616-486-6702
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 MICHIGAN ST NE MC845
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49503-2560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-486-6790
-----------------------------------------------------
Fax | 616-486-6702
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 202C00000X
-----------------------------------------------------
Taxonomy Name | Independent Medical Examiner Physician
-----------------------------------------------------
License Number | 0101238614
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | OA091111
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------