Basic Information
| Provider Information | |||||||||
| NPI: | 1598226904 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HUMAYUN | ||||||||
| FirstName: | AFSHIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 WALLINWOOD AVE NE | ||||||||
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| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495033726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195399836 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 AKRON GENERAL AVE | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443072432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303446000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2019 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 35.144436 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02299377 | 05 | OH | MEDICAID |