Basic Information
| Provider Information | |||||||||
| NPI: | 1336404540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAFQAT | ||||||||
| FirstName: | IMRAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117W PATERSON ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490072557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693492641 | ||||||||
| FaxNumber: | 2692012855 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 OAKLAND DR | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490081282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693374400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2012 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4301100989 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 4301100989 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.