Basic Information
| Provider Information | |||||||||
| NPI: | 1154310621 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAHEEN | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1314 S LINDEN RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421700 | ||||||||
| FaxNumber: | 8107204035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 09/30/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101008990 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | C2919 | 01 | MI | MCARE | OTHER | E26685 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER | 0152508425 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 080D410020 | 01 | MA | BLUE CARE NETWORK | OTHER | 4237665 | 01 | MI | AETNA | OTHER | 4386814 | 05 | MI | MEDICAID | 0089002500 | 01 | MI | HEALTH PLUS | OTHER | 204395 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | 204395 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 2938395001 | 01 | MI | CIGNA | OTHER | 080D410020 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 080095728/CD3616 | 01 | MI | METRAHEALTH | OTHER | E26685 | 01 | MI | HEALTH NET FEDERAL | OTHER |