Provider Demographics
NPI:1134412802
Name:SHABAZZ, KARIMAH Z (DPM)
Entity type:Individual
Prefix:DR
First Name:KARIMAH
Middle Name:Z
Last Name:SHABAZZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4354 QUEEN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1106
Mailing Address - Country:US
Mailing Address - Phone:216-394-9593
Mailing Address - Fax:866-991-7241
Practice Address - Street 1:6600 LYNDALE AVE S STE 130
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-3398
Practice Address - Country:US
Practice Address - Phone:612-788-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN985213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00001005944OtherANTHEM BCBS
MN1134412802Medicaid
OH0116788Medicaid