Provider Demographics
NPI:1811924061
Name:SHAMOON, ZAFAR A (DO)
Entity type:Individual
Prefix:DR
First Name:ZAFAR
Middle Name:A
Last Name:SHAMOON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41034 MARKS DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4932
Mailing Address - Country:US
Mailing Address - Phone:585-922-2000
Mailing Address - Fax:
Practice Address - Street 1:6245 INKSTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-4001
Practice Address - Country:US
Practice Address - Phone:734-458-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015676207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0153311295OtherBCBS INDIVIDUAL PIN
MI4715190Medicaid
MI4715126Medicaid
MIN37250027Medicare ID - Type Unspecified
MI4715126Medicaid
MIC36132030Medicare ID - Type Unspecified