Provider Demographics
NPI:1235315342
Name:ANSARI, SHAPOOR SHALILVAND (M D)
Entity Type:Individual
Prefix:DR
First Name:SHAPOOR
Middle Name:SHALILVAND
Last Name:ANSARI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4206
Mailing Address - Country:US
Mailing Address - Phone:734-243-4000
Mailing Address - Fax:
Practice Address - Street 1:2590 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4206
Practice Address - Country:US
Practice Address - Phone:734-243-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52630208G00000X
MI4301032566208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)