Individual
BEHROOZ SHABAHANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
250 CHERRY SE, GRAND RAPIDS, MI 49503
(616) 752-5600
Mailing address
245 STATE ST SE, GRAND RAPIDS, MI 49503-4328
(616) 913-1818
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301066890
MI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
4301066890
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4851370
—
MI
05
—
4878005
—
MI
Enumeration date
07/09/2006
Last updated
10/11/2023
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