Provider Demographics
NPI:1306891841
Name:SHAFAIE, FARID F (MD)
Entity type:Individual
Prefix:
First Name:FARID
Middle Name:F
Last Name:SHAFAIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 IOWA AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7401
Mailing Address - Country:US
Mailing Address - Phone:951-786-0801
Mailing Address - Fax:708-783-3164
Practice Address - Street 1:3249 SOUTH OAK PARK AVE.
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:708-783-3152
Practice Address - Fax:708-783-3164
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV120902085N0700X
DEC1-00256502085R0202X
OH35-07-4492-S2085R0202X
VA01010498092085R0202X
MDD570872085R0202X
MO1100622085R0202X
IL036-1075622085R0202X
FLME1342542085R0202X
TXL61732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361075621Medicaid
300134723OtherRR MEDICARE
G30582Medicare UPIN
IL0361075621Medicaid
300134723OtherRR MEDICARE
OH0856582Medicare ID - Type Unspecified