Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 336.085504 | IL |
N | 111NI0900X | Internist | 336.085504 | IL |
Y | 207R00000X | Internist | 4301095729 | MI |
Y | 111NI0900X | Internist | 4301095729 | MI |
N | 207RA0401X | Internist - Addiction Medicine | 4301095729 | MI |
NPI | 1023340700 |
---|---|
Provider Name | Dr. Ahed Zayzafoon |
First Address | Kalamazoo, MI 49007-5341 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2010 |
Last Update Date | 24/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023340700 | (05) | MI |
1235131137 | BCBSM - BLH (01) | MI |
1417961137 | BCBSM - BMH (01) | MI |
Z215-0007-6163 | DRIVER LICENSE (01) | IL |