Provider Demographics
NPI:1326121823
Name:AHMED, SHAFI J (MD)
Entity Type:Individual
Prefix:
First Name:SHAFI
Middle Name:J
Last Name:AHMED
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:G4007 W COURT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3560
Mailing Address - Country:US
Mailing Address - Phone:810-732-7716
Mailing Address - Fax:810-732-7863
Practice Address - Street 1:G4007 W COURT ST
Practice Address - Street 2:SUITE B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3560
Practice Address - Country:US
Practice Address - Phone:810-732-7716
Practice Address - Fax:810-732-7863
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3331400Medicaid
MI080B512470OtherBLUE CROSS BLUE SHIELD
MI3331400Medicaid
MIF71175Medicare UPIN