Provider Demographics
NPI:1821495110
Name:SHAHZAD, IFTIKHAR
Entity Type:Individual
Prefix:
First Name:IFTIKHAR
Middle Name:
Last Name:SHAHZAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24152 WATERCREST CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2716
Mailing Address - Country:US
Mailing Address - Phone:248-747-3092
Mailing Address - Fax:
Practice Address - Street 1:24152 WATERCREST CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2716
Practice Address - Country:US
Practice Address - Phone:248-747-3092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist