Provider Demographics
NPI:1003854100
Name:SHABBIR AHMED MD PC
Entity Type:Organization
Organization Name:SHABBIR AHMED MD PC
Other - Org Name:DOWNRIVER ONCOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHABBIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-675-7260
Mailing Address - Street 1:18600 VAN HORN RD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3828
Mailing Address - Country:US
Mailing Address - Phone:734-675-7260
Mailing Address - Fax:734-675-9060
Practice Address - Street 1:18600 VAN HORN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-3828
Practice Address - Country:US
Practice Address - Phone:734-675-7260
Practice Address - Fax:734-675-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059486261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32590Medicare PIN
MIG64019Medicare UPIN