Healthcare Provider Details

I. General information

NPI: 1659245173
Provider Name (Legal Business Name): SHABIR BARKZAI PA-S2
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2597 MARTINA DR APT 15
HOLT MI
48842-1164
US

IV. Provider business mailing address

2597 MARTINA DR APT 15
HOLT MI
48842-1164
US

V. Phone/Fax

Practice location:
  • Phone: 858-952-9976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601014320
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: