Provider Demographics
NPI:1487622296
Name:INFUSION ASSOCIATES PLLC
Entity type:Organization
Organization Name:INFUSION ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAN
Authorized Official - Middle Name:JAVAN
Authorized Official - Last Name:NEDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-954-0600
Mailing Address - Street 1:3230 EAGLE PARK DR NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7007
Mailing Address - Country:US
Mailing Address - Phone:616-954-0600
Mailing Address - Fax:
Practice Address - Street 1:3230 EAGLE PARK DR NE
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7007
Practice Address - Country:US
Practice Address - Phone:616-954-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110D111790OtherBCBSM
CJ6657OtherRAILROAD MEDICARE
MI0N43480Medicare PIN
MI0N48650Medicare PIN