Provider Demographics
NPI:1568865525
Name:SHAFA MOBILE DIAGNOSTIC MANAGEMENT INC
Entity Type:Organization
Organization Name:SHAFA MOBILE DIAGNOSTIC MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:NIZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-591-4184
Mailing Address - Street 1:2801 REGAL RD
Mailing Address - Street 2:STE 110
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6315
Mailing Address - Country:US
Mailing Address - Phone:972-612-2600
Mailing Address - Fax:972-612-2602
Practice Address - Street 1:2801 REGAL RD
Practice Address - Street 2:STE 110
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6315
Practice Address - Country:US
Practice Address - Phone:972-612-2600
Practice Address - Fax:972-612-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile