Provider Demographics
NPI:1376518175
Name:ANSARI, SHAHID M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHID
Middle Name:M
Last Name:ANSARI
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 1:18320 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3230
Mailing Address - Country:US
Mailing Address - Phone:248-476-9200
Mailing Address - Fax:248-476-9282
Practice Address - Street 1:18320 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3230
Practice Address - Country:US
Practice Address - Phone:248-476-9200
Practice Address - Fax:248-476-9282
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA059174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G07646Medicare UPIN
N82530002Medicare ID - Type Unspecified