Individual
IRINA OMARIEVNA SHANIDZE
Active
Individual
IRINA OMARIEVNA SHANIDZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
4301078150
MI
207RP1001X
Pulmonary Disease Physician
Primary
4301078150
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F37521
BLUE CROSS BLUE SHIELD
MI
05
—
1518977198
—
MI
Enumeration date
08/08/2006
Last updated
12/14/2011
Update your record
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