Provider Demographics
NPI:1417091133
Name:SHAHBAZIAN, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:SHAHBAZIAN
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 1:25982 PALA
Mailing Address - Street 2:SUITE 280
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6719
Mailing Address - Country:US
Mailing Address - Phone:949-297-3838
Mailing Address - Fax:949-297-3839
Practice Address - Street 1:25982 PALA
Practice Address - Street 2:SUITE #280
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6719
Practice Address - Country:US
Practice Address - Phone:949-297-3838
Practice Address - Fax:949-297-3839
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91591207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAN981ZMedicare PIN
CAAN981ZMedicare PIN