1861473209 NPI number — DR. SHABANA RASHEED MD

Table of content: DR. SHABANA RASHEED MD (NPI 1861473209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861473209 NPI number — DR. SHABANA RASHEED MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASHEED
Provider First Name:
SHABANA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1861473209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24060 W 9 MILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48033-3904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-443-6027
Provider Business Mailing Address Fax Number:
248-356-4940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24060 W 9 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48033-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-356-5900
Provider Business Practice Location Address Fax Number:
248-356-4940
Provider Enumeration Date:
11/11/2005

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: 207R00000X , with the licence number:  4301064947 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 4301364947 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 017019 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11362 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 122007 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1861473209 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4578125-10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6241 . This is a "TOTAL HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1108231391 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00207737 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G64166 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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