Provider Demographics
NPI:1912195835
Name:JAFRI, KAMRAN S (MD)
Entity type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:S
Last Name:JAFRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1200
Mailing Address - Country:US
Mailing Address - Phone:646-262-3135
Mailing Address - Fax:646-626-4235
Practice Address - Street 1:2454 MONROE ST STE A
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3038
Practice Address - Country:US
Practice Address - Phone:313-562-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220892207YX0905X
MI4301072754207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02288957Medicaid
NYA400092777Medicare PIN