Healthcare Provider Details

I. General information

NPI: 1871533083
Provider Name (Legal Business Name): FRANK B SHAHBAHRAMI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 ROMANS CT
BLOOMINGTON IN
47401-8676
US

IV. Provider business mailing address

708 ROMANS CT
BLOOMINGTON IN
47401-8676
US

V. Phone/Fax

Practice location:
  • Phone: 812-334-8958
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01051200A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: