Provider Demographics
NPI:1043525520
Name:BADSHAH, MAAZ BIN (MD)
Entity type:Individual
Prefix:DR
First Name:MAAZ
Middle Name:BIN
Last Name:BADSHAH
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 1:222 STATION PLZ N STE 428
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3819
Mailing Address - Country:US
Mailing Address - Phone:516-663-2066
Mailing Address - Fax:516-663-4617
Practice Address - Street 1:1205 S GRANGE AVE STE 510
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0410
Practice Address - Country:US
Practice Address - Phone:605-328-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036141035207R00000X
IN01072399A207R00000X
ND18947207RG0100X
SD13354207RG0100X
NY297877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201149780Medicaid
IN201149780Medicaid
INP01296001Medicare PIN