Provider Demographics
NPI:1730276981
Name:SHAFI J AHMED MD PC
Entity type:Organization
Organization Name:SHAFI J AHMED MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAFI
Authorized Official - Middle Name:J
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-732-7716
Mailing Address - Street 1:G4007 W COURT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3560
Mailing Address - Country:US
Mailing Address - Phone:810-732-7716
Mailing Address - Fax:810-732-7863
Practice Address - Street 1:G4007 W COURT ST
Practice Address - Street 2:SUITE B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3560
Practice Address - Country:US
Practice Address - Phone:810-732-7716
Practice Address - Fax:810-732-7863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301023712207Q00000X
MI4301056194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080B512470OtherBLUE CROSS BLUE SHIELD
MI3331400Medicaid
MI080B512470OtherBLUE CROSS BLUE SHIELD
MIF71175Medicare UPIN