Healthcare Provider Details

I. General information

NPI: 1699852459
Provider Name (Legal Business Name): SHAHEEN PARVEZ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 45TH AVE
MUNSTER IN
46321-3914
US

IV. Provider business mailing address

PO BOX 516
SCHERERVILLE IN
46375-0516
US

V. Phone/Fax

Practice location:
  • Phone: 219-513-0999
  • Fax: 219-513-9032
Mailing address:
  • Phone: 219-513-0999
  • Fax: 219-513-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01039726
License Number StateIN

VIII. Authorized Official

Name: SHAHEEN PARVEZ
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 219-513-0999