Provider Demographics
NPI:1831174648
Name:SHAHBANDAR, AHMAD B (MD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:B
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 1:1349 S ROCHESTER RD
Mailing Address - Street 2:STE 105
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3150
Mailing Address - Country:US
Mailing Address - Phone:248-652-6336
Mailing Address - Fax:248-652-6339
Practice Address - Street 1:1349 S ROCHESTER RD
Practice Address - Street 2:STE 105
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3150
Practice Address - Country:US
Practice Address - Phone:248-652-6336
Practice Address - Fax:248-652-6339
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070530207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F39067Medicare UPIN
MIMI6739Medicare PIN