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Organization
AMELIA FAJARDO FAMILY MEDICAL CLINIC PC
Active
Organization
AMELIA FAJARDO FAMILY MEDICAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMELIA FAJARDO MD (OWNER)
(616) 617-9974
Entity
Organization
Contact information
Practice address
450 MEDICAL PARK DR, SUITE 100, WATERVLIET, MI 49098-8531
(269) 463-3125
Mailing address
4305 DIVISION AVE S, GRAND RAPIDS, MI 49548-3315
(616) 617-9974
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4301030837
MI
Other
Enumeration date
11/05/2010
Last updated
05/11/2011
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