Provider Demographics
NPI:1174111520
Name:SHABANI-RAD, MEER-TAHER
Entity type:Individual
Prefix:
First Name:MEER-TAHER
Middle Name:
Last Name:SHABANI-RAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CHRISTIE PARK VIEW SW
Mailing Address - Street 2:
Mailing Address - City:CALGARY
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T3H 2Y7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 CHRISTIE PARK VIEW SW
Practice Address - Street 2:
Practice Address - City:CALGARY
Practice Address - State:ALBERTA
Practice Address - Zip Code:T3H 2Y7
Practice Address - Country:CA
Practice Address - Phone:403-944-4754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96491207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology