Provider Demographics
NPI:1326091331
Name:FEROZ, SHABANA (MD)
Entity Type:Individual
Prefix:
First Name:SHABANA
Middle Name:
Last Name:FEROZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:989-742-4583
Mailing Address - Fax:989-742-4298
Practice Address - Street 1:7840 VINEWOOD LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7185
Practice Address - Country:US
Practice Address - Phone:763-236-0200
Practice Address - Fax:763-420-5531
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4162464Medicaid
MI4884782Medicaid
MI4162375Medicaid
MI0F06016OtherMEDICARE BILL PAY TO
MI4162455Medicaid
H07394Medicare UPIN
MN80023042Medicare PIN