Provider Demographics
NPI:1376512111
Name:ABBASI, SHAHZAMAN (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAHZAMAN
Middle Name:
Last Name:ABBASI
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 1:1540 LAKE LANSING RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3757
Mailing Address - Country:US
Mailing Address - Phone:517-913-3810
Mailing Address - Fax:517-913-3811
Practice Address - Street 1:1540 LAKE LANSING RD STE 102
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3757
Practice Address - Country:US
Practice Address - Phone:517-913-3810
Practice Address - Fax:517-913-3811
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1103313482OtherBCBS
MI200000007490OtherPHP FAMILYCARE
MI1027866OtherMCLAREN HEALTH PLAN-MEDICAID
MI200000007490OtherPHP
MI0M21440059OtherMEDICARE PLUS BLUE
MI1027866OtherMCLAREN HEALTH ADVANTAGE
MI1027866OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI5176203OtherMEDICAID
MIP00437870OtherRAILROAD MEDICARE
11-0-78-1024-2OtherBC OF MI
MI1376512111Medicaid
MI1027866OtherMCLAREN
MI7062622OtherAETNA
MI1027866OtherMCLAREN
MI1027866OtherMCLAREN HEALTH PLAN-COMMERCIAL
MIM86580006Medicare ID - Type Unspecified