Healthcare Provider Details

I. General information

NPI: 1689006090
Provider Name (Legal Business Name): AMJAD SHAHAB CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 09/18/2026
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45211 HELM ST
PHYMOUTH MI
48170
US

IV. Provider business mailing address

45211 HELM ST
PHYMOUTH MI
48170
US

V. Phone/Fax

Practice location:
  • Phone: 480-777-0900
  • Fax: 480-777-1345
Mailing address:
  • Phone: 480-777-0900
  • Fax: 480-777-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: