Provider Demographics
NPI:1437420296
Name:SHIRAZI, ENAYAT K
Entity Type:Individual
Prefix:
First Name:ENAYAT
Middle Name:K
Last Name:SHIRAZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3996 QUAIL HILL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-7826
Mailing Address - Country:US
Mailing Address - Phone:765-966-4488
Mailing Address - Fax:
Practice Address - Street 1:3996 QUAIL HILL DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-7826
Practice Address - Country:US
Practice Address - Phone:765-966-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024272A207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck