Provider Demographics
NPI:1275526048
Name:SHOKOOHI, FARHAD K (MD)
Entity Type:Individual
Prefix:
First Name:FARHAD
Middle Name:K
Last Name:SHOKOOHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2393 SCHUST RD
Mailing Address - Street 2:GREAT LAKES EYE INSTITUTE
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1334
Mailing Address - Country:US
Mailing Address - Phone:989-793-2820
Mailing Address - Fax:989-793-9132
Practice Address - Street 1:2393 SCHUST RD
Practice Address - Street 2:GREAT LAKES EYE INSTITUTE
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1334
Practice Address - Country:US
Practice Address - Phone:989-793-2820
Practice Address - Fax:989-793-9132
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301040619207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0467800005OtherADMINASTAR
MI2622510Medicaid
0467800001OtherADMINASTAR
0467800006OtherADMINASTAR
MI4301040619OtherLICENSE NUMBER
MI1359493Medicaid
MI180G300890OtherBLUE CARE NETWORK
0467800004OtherADMINASTAR
0467800002OtherADMINASTAR
MI180G300890OtherBLUE CROSS BLUE SHIELD
MICA3610OtherRAILROAD MEDICARE
0467800002OtherADMINASTAR
0467800001OtherADMINASTAR