Provider Demographics
NPI:1699004945
Name:SHAPOOR S ANSARI PC
Entity Type:Organization
Organization Name:SHAPOOR S ANSARI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAPOOR
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-243-4000
Mailing Address - Street 1:2590 NORTH MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:734-243-4003
Practice Address - Street 1:2590 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4206
Practice Address - Country:US
Practice Address - Phone:734-243-4000
Practice Address - Fax:734-243-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty