MEDICARE: SHAHRIAR BOZORGZADEH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	60114769	WA
2	207Q00000X	Family Medicine Physician	60114769	WA

General Provider Information

NPI Number	:	1194726851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHRIAR BOZORGZADEH MD

Provider Business Mailing Address
First Line	:	PO BOX 1467
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206-1467
Country	:	US
Telephone Number	:	618-457-5200
Fax Number	:	618-529-0586

Provider Business Practice Location Address
First Line	:	1050 LAKEWAY DR
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-2020
Country	:	US
Telephone Number	:	360-746-6531
Fax Number	:	360-746-6266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	10/31/2024

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