Provider Demographics
NPI:1952380107
Name:SAFDAR, SHABBIR H (MD)
Entity Type:Individual
Prefix:DR
First Name:SHABBIR
Middle Name:H
Last Name:SAFDAR
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 1:4921 PARKVIEW PL
Mailing Address - Street 2:SUITE 14C
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:314-290-7555
Mailing Address - Fax:314-290-7550
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:SUITE 14C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-290-7555
Practice Address - Fax:314-290-7550
Is Sole Proprietor?:No
Enumeration Date:2006-01-15
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3981207RH0003X
IL336010862207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL304010OtherMEDICARE IL
IL036043159Medicaid
IL105905OtherIL WORKER'S COMP
MO123513OtherWORKMEN'S COMP
MO201262128Medicaid
IL105905OtherIL WORKER'S COMP
IL036043159Medicaid
MO201262128Medicaid
ILA11002Medicare UPIN
MO123513OtherWORKMEN'S COMP
MO000013533Medicare PIN
MO001011378Medicare ID - Type UnspecifiedMO MEDICARE