1497901110 NPI number — MR. JAHANDAR SAIFOLLAHI MD

Table of content: MR. JAHANDAR SAIFOLLAHI MD (NPI 1497901110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497901110 NPI number — MR. JAHANDAR SAIFOLLAHI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAIFOLLAHI
Provider First Name:
JAHANDAR
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497901110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1596
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49016-1596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-969-6108
Provider Business Mailing Address Fax Number:
269-969-8732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SADDLE BACK CENTER, BUILDING 751-E KENMORE AVENUE, S.E.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546-2391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-977-1770
Provider Business Practice Location Address Fax Number:
616-977-1775
Provider Enumeration Date:
08/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  4301079449 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)