Provider Demographics
NPI:1427041045
Name:SHOKOOHI, KAMRAN K (MD PHD)
Entity Type:Individual
Prefix:
First Name:KAMRAN
Middle Name:K
Last Name:SHOKOOHI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2393 SCHUST RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1334
Mailing Address - Country:US
Mailing Address - Phone:989-793-2820
Mailing Address - Fax:989-793-9132
Practice Address - Street 1:2393 SCHUST RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1334
Practice Address - Country:US
Practice Address - Phone:989-793-2820
Practice Address - Fax:989-793-9132
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067707207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4182000Medicaid
0G36036OtherMEDICARE
MI180G300890OtherBLUE CROSS BLUE SHIELD
MI1427090976OtherGROUP NPI
180G300890OtherBLUE CARE NETWORK
MI4187472Medicaid
MI43010067707OtherLICENSE
CA3610OtherRAILROAD MEDICARE
CA3610OtherRAILROAD MEDICARE