# AMELIA FAJARDO FAMILY MEDICAL CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265733356
- **Authorized official:** AMELIA FAJARDO MD (OWNER)
- **Authorized official phone:** (616) 617-9974

## Contact information

- **Practice address:** 450 MEDICAL PARK DR, SUITE 100, WATERVLIET, MI 49098-8531
- **Practice address phone:** (269) 463-3125
- **Mailing address:** 4305 DIVISION AVE S, GRAND RAPIDS, MI 49548-3315
- **Mailing address phone:** (616) 617-9974

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 4301030837 | MI | Yes |

## Other

- **Enumeration date:** 11/05/2010
- **Last updated:** 05/11/2011