Healthcare Provider Details

I. General information

NPI: 1881322287
Provider Name (Legal Business Name): SHABBIR HAIDERBHAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 4TH ST N
FARGO ND
58102-4539
US

IV. Provider business mailing address

4550 49TH AVE S APT 314
FARGO ND
58104-4555
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-6161
  • Fax:
Mailing address:
  • Phone: 248-778-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number22281
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: