Healthcare Provider Details

I. General information

NPI: 1538164140
Provider Name (Legal Business Name): SHAHABUL ARFEEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9836 W 400 N STE B
MICHIGAN CITY IN
46360-2910
US

IV. Provider business mailing address

801 MACARTHUR BLVD SUITE 400A
MUNSTER IN
46321-2915
US

V. Phone/Fax

Practice location:
  • Phone: 219-878-9531
  • Fax: 219-878-0261
Mailing address:
  • Phone: 219-931-5227
  • Fax: 219-932-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01043606A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01043606
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: