1639149628 NPI number — MR. SHAHEEN PARVEZ MD

Table of content: MR. SHAHEEN PARVEZ MD (NPI 1639149628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639149628 NPI number — MR. SHAHEEN PARVEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARVEZ
Provider First Name:
SHAHEEN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639149628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1640 45TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNSTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-513-0999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1640 45TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-513-0999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  01039726A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 01039726A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 930128582 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 036082858 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90001082 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01039726A . This is a "LICENSE IN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200257526 . This is a "TAX ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100473750 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100047375013B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000278480 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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