Provider Demographics
NPI:1649474321
Name:DR ABBASS SHAFII M D P C
Entity type:Organization
Organization Name:DR ABBASS SHAFII M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBASS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFII
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1719-473-6115
Mailing Address - Street 1:715 N WEBER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1091
Mailing Address - Country:US
Mailing Address - Phone:171-947-3611
Mailing Address - Fax:171-947-3368
Practice Address - Street 1:715 N WEBER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1091
Practice Address - Country:US
Practice Address - Phone:171-947-3611
Practice Address - Fax:171-947-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04021358Medicaid
COC398708Medicare ID - Type UnspecifiedMEDICARE PROVIDER GRPUP #