Provider Demographics
NPI:1912093345
Name:NOORANI, SHAFIQ S
Entity Type:Individual
Prefix:
First Name:SHAFIQ
Middle Name:S
Last Name:NOORANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SHAFIQ
Other - Middle Name:
Other - Last Name:NOORANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4451
Mailing Address - Fax:970-490-4199
Practice Address - Street 1:16951 E QUINCY AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1901
Practice Address - Country:US
Practice Address - Phone:303-752-5480
Practice Address - Fax:303-752-5481
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1033207P00000X
CO2864363A00000X
COPA.0002864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01244915OtherRAILROAD MEDICARE
CO17728860Medicaid
P00717649OtherRAILROAD MCR
P00717649OtherRAILROAD MCR
COP01244915OtherRAILROAD MEDICARE