Individual
DR. MUHAMMAD SHAHZAD MUMTAZ ANSARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5215 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1469
(574) 335-4145
(574) 335-4146
Mailing address
5215 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1469
(574) 335-8700
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01076678A
IN
208000000X
Pediatrics Physician
036132394
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
82081-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001019988
ANTHEM BCBS
IN
05
—
201375060
—
IN
Enumeration date
07/19/2010
Last updated
01/13/2026
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