Provider Demographics
NPI:1003878133
Name:PARVAZ, SHAHZAD A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHZAD
Middle Name:A
Last Name:PARVAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4503
Mailing Address - Country:US
Mailing Address - Phone:812-917-5109
Mailing Address - Fax:812-917-5071
Practice Address - Street 1:4511 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4503
Practice Address - Country:US
Practice Address - Phone:812-917-5109
Practice Address - Fax:812-917-5071
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058702A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200106270Medicaid
IN000000477987OtherBCBS
945520YYYMedicare PIN
264990BMedicare PIN
IN200106270Medicaid
IN000000477987OtherBCBS