Individual
AFTAB A AFTAB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10118 N CLIO RD, CLIO, MI 48420-1943
(810) 686-5635
(810) 686-0988
Mailing address
10118 N CLIO RD, CLIO, MI 48420-1943
(810) 686-5635
(810) 686-0988
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
AA032532
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3048661
—
MI
Enumeration date
11/16/2005
Last updated
10/29/2007
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