Basic Information
| Provider Information | |||||||||
| NPI: | 1619263829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IMRAN | ||||||||
| FirstName: | SIKANDAR | ||||||||
| MiddleName: | SHAHZAD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 PORTLAND AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859225067 | ||||||||
| FaxNumber: | 5859222908 | ||||||||
| Practice Location | |||||||||
| Address1: | 1425 PORTLAND AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859225067 | ||||||||
| FaxNumber: | 5859222908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2011 | ||||||||
| LastUpdateDate: | 02/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 275179 | NY | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 275179 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | MD043879 | DC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 03884306 | 05 | NY | MEDICAID | 03007063/NWK | 05 | NY | MEDICAID | 01131126/RGH | 05 | NY | MEDICAID |