Provider Demographics
NPI:1922007749
Name:SHAHBANDAR, TAREK H (MD)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:H
Last Name:SHAHBANDAR
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 1:8687 CONNECTICUT ST
Mailing Address - Street 2:STE D
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5541
Mailing Address - Country:US
Mailing Address - Phone:219-750-9630
Mailing Address - Fax:219-750-9451
Practice Address - Street 1:8687 CONNECTICUT ST
Practice Address - Street 2:STE D
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5541
Practice Address - Country:US
Practice Address - Phone:219-750-9630
Practice Address - Fax:219-750-9451
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058916A207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200489820AMedicaid
IN200489820AMedicaid
IN409950HMedicare PIN
INP01051985Medicare PIN
INI16345Medicare UPIN