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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