Healthcare Provider Details

I. General information

NPI: 1831174648
Provider Name (Legal Business Name): AHMAD B SHAHBANDAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 S ROCHESTER RD STE 105
ROCHESTER HILLS MI
48307-3150
US

IV. Provider business mailing address

1349 S ROCHESTER RD STE 105
ROCHESTER HILLS MI
48307-3150
US

V. Phone/Fax

Practice location:
  • Phone: 248-652-6336
  • Fax: 248-652-6339
Mailing address:
  • Phone: 248-652-6336
  • Fax: 248-652-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301070530
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: