Provider Demographics
NPI:1588151419
Name:GHAFFAR, SEEMA
Entity type:Individual
Prefix:
First Name:SEEMA
Middle Name:
Last Name:GHAFFAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 GREENWAY LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-4795
Mailing Address - Country:US
Mailing Address - Phone:248-310-1929
Mailing Address - Fax:
Practice Address - Street 1:3633 BREAKERS DR
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1054
Practice Address - Country:US
Practice Address - Phone:708-294-2245
Practice Address - Fax:708-294-2256
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005294208100000X
IL070027082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation