Provider Demographics
NPI:1154711299
Name:SHAHZAD ANWAR MD INC
Entity type:Organization
Organization Name:SHAHZAD ANWAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-788-8222
Mailing Address - Street 1:1478 STONE POINT DR # 290
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2869
Mailing Address - Country:US
Mailing Address - Phone:916-788-8222
Mailing Address - Fax:916-710-8335
Practice Address - Street 1:1478 STONE POINT DR # 290
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2869
Practice Address - Country:US
Practice Address - Phone:916-788-8222
Practice Address - Fax:916-710-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty