Provider Demographics
NPI:1679557979
Name:KAFTAN, SHELDON N (DO)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:N
Last Name:KAFTAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27483 DEQUINDRE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3491
Mailing Address - Country:US
Mailing Address - Phone:248-547-6603
Mailing Address - Fax:248-547-5696
Practice Address - Street 1:27483 DEQUINDRE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3491
Practice Address - Country:US
Practice Address - Phone:248-547-6603
Practice Address - Fax:248-547-5696
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101004775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H217350OtherBLUE SHIELD
MI1679557979Medicaid
MI700H217350OtherBLUE SHIELD
MI1679557979Medicaid
MI0M92440016Medicare PIN