Provider Demographics
NPI:1831155688
Name:SHOKOUH-AMIRI, HOSEIN M (MD)
Entity type:Individual
Prefix:DR
First Name:HOSEIN
Middle Name:M
Last Name:SHOKOUH-AMIRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2751 ALBERT BICKNELL DR
Mailing Address - Street 2:STE 4A
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103
Mailing Address - Country:US
Mailing Address - Phone:318-212-4275
Mailing Address - Fax:318-212-8511
Practice Address - Street 1:2751 ALBERT BICKNELL DR
Practice Address - Street 2:STE 4A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103
Practice Address - Country:US
Practice Address - Phone:318-212-4275
Practice Address - Fax:318-212-8511
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN24176204F00000X
LA20118204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3073281Medicaid
167279OtherBC/BS TN
AR123102001Medicaid
TN3073281Medicaid
F58008Medicare UPIN