Provider Demographics
NPI:1558558320
Name:SHALABI, AHMED A (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:A
Last Name:SHALABI
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 1:8308 FENTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8881
Mailing Address - Country:US
Mailing Address - Phone:810-893-5400
Mailing Address - Fax:810-893-5492
Practice Address - Street 1:1020 CHARTER DR STE A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3584
Practice Address - Country:US
Practice Address - Phone:810-893-5400
Practice Address - Fax:810-893-5492
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40932208C00000X
MI4301102175208C00000X, 208600000X
PAMD4315762086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558558320Medicaid
MI1558558320Medicaid