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1427041045

NPI Code Detail

MEDICARE: KAMRAN K SHOKOOHI MD PHD

MEDICARE: KAMRAN K SHOKOOHI MD PHD

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	4301067707	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0G36036	OTHER		MEDICARE
8	CA3610	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	180G300890	OTHER	MI	BLUE CROSS BLUE SHIELD
4	1427090976	OTHER	MI	GROUP NPI
5	180G300890	OTHER		BLUE CARE NETWORK
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	43010067707	OTHER	MI	LICENSE

General Provider Information

NPI Number	:	1427041045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMRAN K SHOKOOHI MD PHD

Provider Business Mailing Address
First Line	:	2393 SCHUST RD
Second Line	:
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	:
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	:	08/30/2005
Last Update Date	:	09/18/2023

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Directions to “ KAMRAN K SHOKOOHI MD PHD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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