Provider Demographics
NPI:1932769577
Name:MANZOOR, IRFAN SHAUKAT (MD)
Entity Type:Individual
Prefix:
First Name:IRFAN
Middle Name:SHAUKAT
Last Name:MANZOOR
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 1:4000 WELLNESS CHRISTIE BLDG
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670-2000
Mailing Address - Country:US
Mailing Address - Phone:989-839-3500
Mailing Address - Fax:
Practice Address - Street 1:40 W SAGINAW RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:MI
Practice Address - Zip Code:48657-9206
Practice Address - Country:US
Practice Address - Phone:989-687-9940
Practice Address - Fax:989-687-9945
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4351045186207Q00000X, 390200000X
MI4301508716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program