Provider Demographics
NPI:1629193123
Name:SHAHZAD, KHAWAJA (MD)
Entity Type:Individual
Prefix:
First Name:KHAWAJA
Middle Name:
Last Name:SHAHZAD
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 1:2770 CENTENNIAL RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1829
Mailing Address - Country:US
Mailing Address - Phone:419-794-0567
Mailing Address - Fax:419-794-0569
Practice Address - Street 1:2770 CENTENNIAL RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1829
Practice Address - Country:US
Practice Address - Phone:419-794-0567
Practice Address - Fax:419-794-0569
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 0840272084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4641013Medicaid
OH2527359Medicaid
04543OtherPARAMOUNT HEALTH CARE
734628-000OtherMAGELLAN HEALTH SERVICES
MI4641013Medicaid
H28631Medicare UPIN