Organization
AFTON NEPHROLOGY ASSOCIATES
Active
Other names
State Fair Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RACHEL DONALDSON M.D. (CEO)
(313) 893-8610
Entity
Organization
Contact information
Practice address
19800 WOODWARD AVE, DETROIT, MI 48203-5102
(313) 893-8610
Mailing address
19800 WOODWARD AVE, DETROIT, MI 48203-5102
(313) 893-8610
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
4301406139
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08999
BCN
MI
01
—
14040
MCARE
MI
01
—
49441
OMNICARE
MI
01
—
9367
CAPE HEALTH PLAN
MI
01
—
D9411
BCBS
MI
Enumeration date
09/16/2006
Last updated
04/20/2008
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