Provider Demographics
NPI:1538265335
Name:AFTON NEPHROLOGY ASSOCIATES
Entity type:Organization
Organization Name:AFTON NEPHROLOGY ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-893-8610
Mailing Address - Street 1:19800 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-5102
Mailing Address - Country:US
Mailing Address - Phone:313-893-8610
Mailing Address - Fax:
Practice Address - Street 1:19800 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-5102
Practice Address - Country:US
Practice Address - Phone:313-893-8610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406139261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI49441OtherOMNICARE
MI9367OtherCAPE HEALTH PLAN
MID9411OtherBCBS
MI08999OtherBCN
MI08999OtherBCBS
MI14040OtherMCARE
MI=========OtherAETNA
MI08999OtherBCN
MI14040OtherMCARE
MI9367OtherCAPE HEALTH PLAN
MID9411OtherBCBS
MI=========OtherGREAT LAKES