Amelia Fajardo Family Medical Clinic PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

4301030837 Issued in MI

Legal business name

AMELIA FAJARDO FAMILY MEDICAL CLINIC PC

Practice address

450 Medical Park Dr
Suite 100
Watervliet, MI 49098-8531

Phone

(269) 463-3125

NPI assigned

Nov 5, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amelia Fajardo, MD

Title

Owner

Phone

(616) 617-9974

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kathleen Basha, PA-C

  • Medical Physician Assistant
  • Dowagiac, MI
  • NPI 1083932685
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305072000000",
    "number": "1265733356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4305 DIVISION AVE S",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495483315",
            "telephone_number": "616-617-9974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 MEDICAL PARK DR",
            "address_2": "SUITE 100",
            "city": "WATERVLIET",
            "state": "MI",
            "postal_code": "490988531",
            "telephone_number": "269-463-3125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMELIA FAJARDO FAMILY MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-05",
        "last_updated": "2011-05-11",
        "status": "A",
        "authorized_official_last_name": "FAJARDO",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-617-9974",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301030837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Watervliet, MI
• Providers in Watervliet, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.