Provider Demographics
NPI:1184834954
Name:BAHRAMI, SHAHNAM NAMI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHNAM
Middle Name:NAMI
Last Name:BAHRAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7237 CEDARWOOD PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5423
Mailing Address - Country:US
Mailing Address - Phone:818-618-9204
Mailing Address - Fax:920-320-5106
Practice Address - Street 1:7237 CEDARWOOD PL
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5423
Practice Address - Country:US
Practice Address - Phone:818-618-9204
Practice Address - Fax:920-320-5106
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN62978207P00000X
WI57669-20207P00000X
MI4301088813207P00000X
CAA107510207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI57669OtherLICENSE