Healthcare Provider Details

I. General information

NPI: 1538401658
Provider Name (Legal Business Name): GASSAN SHAHIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31471 NORTHWESTERN HWY SUITE # 3
FARMINGTON HILLS MI
48334
US

IV. Provider business mailing address

27328 CLAIRVIEW DR
DEARBORN MI
48127
US

V. Phone/Fax

Practice location:
  • Phone: 313-570-2392
  • Fax:
Mailing address:
  • Phone: 313-570-2392
  • Fax: 313-278-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GASSAN SHAHIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 313-570-2392