1093992141 NPI number — RASHAD SHAHEED BA FAODP

Table of content: RASHAD SHAHEED BA FAODP (NPI 1093992141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093992141 NPI number — RASHAD SHAHEED BA FAODP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAHEED
Provider First Name:
RASHAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA FAODP
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:
1093992141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12501 HAMILTON AVE
Provider Second Line Business Mailing Address:
2168 CHENE ST.
Provider Business Mailing Address City Name:
HIGHLAND PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48203-3243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-320-4736
Provider Business Mailing Address Fax Number:
313-865-1582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12501 HAMILTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48203-3243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-320-3647
Provider Business Practice Location Address Fax Number:
313-865-1582
Provider Enumeration Date:
01/30/2008

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1093992141 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1093992141 . This is a "TAXONAMY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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