MEDICARE: SHABBIR AHMED MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0200X	Oncology Clinic/Center	4301059486	MI

General Provider Information

NPI Number	:	1003854100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHABBIR AHMED MD PC

Provider Business Mailing Address
First Line	:	18600 VAN HORN RD
Second Line	:
City	:	WOODHAVEN
State	:	MI
Zip	:	48183-3828
Country	:	US
Telephone Number	:	734-675-7260
Fax Number	:	734-675-9060

Provider Business Practice Location Address
First Line	:	18600 VAN HORN RD
Second Line	:
City	:	WOODHAVEN
State	:	MI
Zip	:	48183-3828
Country	:	US
Telephone Number	:	734-675-7260
Fax Number	:	734-675-9060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHABBIR AHMED
Credential	:	MD
Telephone Number	:	734-675-7260

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	04/09/2009

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