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1275526048

NPI Code Detail

MEDICARE: FARHAD K SHOKOOHI MD

MEDICARE: FARHAD K SHOKOOHI MD

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	207W00000X	Ophthalmology Physician	4301040619	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
11	CA3610	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0467800005	OTHER		ADMINASTAR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0467800001	OTHER		ADMINASTAR
4	0467800006	OTHER		ADMINASTAR
5	4301040619	OTHER	MI	LICENSE NUMBER
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	180G300890	OTHER	MI	BLUE CARE NETWORK
8	0467800004	OTHER		ADMINASTAR
9	0467800002	OTHER		ADMINASTAR
10	180G300890	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1275526048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARHAD K SHOKOOHI MD

Provider Business Mailing Address
First Line	:	2393 SCHUST RD
Second Line	:	GREAT LAKES EYE INSTITUTE
City	:	SAGINAW
State	:	MI
Zip	:	48603-1334
Country	:	US
Telephone Number	:	989-793-2820
Fax Number	:	989-793-9132

Provider Business Practice Location Address
First Line	:	2393 SCHUST RD
Second Line	:	GREAT LAKES EYE INSTITUTE
City	:	SAGINAW
State	:	MI
Zip	:	48603-1334
Country	:	US
Telephone Number	:	989-793-2820
Fax Number	:	989-793-9132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	09/18/2023

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Directions to “ FARHAD K SHOKOOHI MD” Practice Location

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