Provider Demographics
NPI:1053426700
Name:MAKOUI, AMIR SHAHRAM (MD)
Entity type:Individual
Prefix:
First Name:AMIR
Middle Name:SHAHRAM
Last Name:MAKOUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4008
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-4008
Mailing Address - Country:US
Mailing Address - Phone:661-266-4500
Mailing Address - Fax:661-266-4502
Practice Address - Street 1:615 WEST AVE Q SUITE D
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551
Practice Address - Country:US
Practice Address - Phone:661-266-4500
Practice Address - Fax:661-266-4502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75531207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA755310OtherBLUESHIELD
CAOOA755310OtherBLUESHIELD
CAH46967Medicare UPIN
CAWA75531AMedicare PIN