Provider Demographics
NPI:1265480842
Name:SHAHBAZI, MICHAEL FARZIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FARZIN
Last Name:SHAHBAZI
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 1:110 MED TECH PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4004
Mailing Address - Country:US
Mailing Address - Phone:423-929-2111
Mailing Address - Fax:423-929-0497
Practice Address - Street 1:110 MED TECH PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4004
Practice Address - Country:US
Practice Address - Phone:423-929-2111
Practice Address - Fax:423-929-0497
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16609207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3054308Medicaid
TN180042544OtherRAILROAD MEDICARE
TN180016465OtherRAILROAD MEDICARE
TN0284010001Medicare NSC
TN180042544OtherRAILROAD MEDICARE
TNE19210Medicare UPIN
TN3054308Medicaid