Provider Demographics
NPI:1699852459
Name:SHAHEEN PARVEZ MD PC
Entity Type:Organization
Organization Name:SHAHEEN PARVEZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-513-0999
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-0516
Mailing Address - Country:US
Mailing Address - Phone:219-513-0999
Mailing Address - Fax:219-513-9032
Practice Address - Street 1:1640 45TH AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3914
Practice Address - Country:US
Practice Address - Phone:219-513-0999
Practice Address - Fax:219-513-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039726208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10047375013 BMedicaid
INE 90772Medicare UPIN
IN209630Medicare PIN