1730276981 NPI number — SHAFI J AHMED MD PC

Table of content: (NPI 1730276981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730276981 NPI number — SHAFI J AHMED MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAFI J AHMED MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COURT STREET FAMILY MEDICINE
Provider Other Organization Name Type Code:
3
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:
1730276981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
G4007 W COURT ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-3560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-732-7716
Provider Business Mailing Address Fax Number:
810-732-7863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
G4007 W COURT ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-3560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-732-7716
Provider Business Practice Location Address Fax Number:
810-732-7863
Provider Enumeration Date:
10/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AHMED
Authorized Official First Name:
SHAFI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
810-732-7716

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301023712 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 4301056194 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080B512470 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3331400 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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