Provider Demographics
NPI:1154310621
Name:SHAHEEN, RONALD E (DO)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:SHAHEEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:1314 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3456
Practice Address - Country:US
Practice Address - Phone:810-342-1700
Practice Address - Fax:810-720-4035
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC2919OtherMCARE
MIE26685OtherHEALTH ALLIANCE PLAN
MI0152508425OtherBLUE CROSS BLUE SHIELD
MA080D410020OtherBLUE CARE NETWORK
MI4237665OtherAETNA
MI4386814Medicaid
MI0089002500OtherHEALTH PLUS
MI204395OtherHEALTH ADVANTAGE NETWORK
MI204395OtherMCLAREN HEALTH PLAN
MI2938395001OtherCIGNA
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI080095728/CD3616OtherMETRAHEALTH
MIE26685OtherHEALTH NET FEDERAL
MIC2919OtherMCARE
MIE26685OtherHEALTH NET FEDERAL
MA080D410020OtherBLUE CARE NETWORK