Provider Demographics
NPI:1568792752
Name:RABBANI, SHEHRZAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEHRZAD
Middle Name:
Last Name:RABBANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-7460
Mailing Address - Country:US
Mailing Address - Phone:913-359-6019
Mailing Address - Fax:
Practice Address - Street 1:36923 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1162
Practice Address - Country:US
Practice Address - Phone:913-359-6001
Practice Address - Fax:913-359-5552
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010861872085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1173500Medicaid
CAFD621ZMedicare PIN