Provider Demographics
NPI:1639149628
Name:PARVEZ, SHAHEEN (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAHEEN
Middle Name:
Last Name:PARVEZ
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 1:1640 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-513-0999
Mailing Address - Fax:
Practice Address - Street 1:1640 45TH ST
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-513-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039726A207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN930128582OtherMEDICARE RAILROAD
IN036082858Medicaid
IL90001082OtherBCBS
IN01039726AOtherLICENSE IN
IN200257526OtherTAX ID
IN100473750Medicaid
IN100047375013BMedicaid
IN000000278480OtherANTHEM BCBS
IN036082858Medicaid
IN01039726AOtherLICENSE IN