MEDICARE: DR. AUGUSTE SHIMWA NIYIBIZI DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101028352	MI
2	207Q00000X	Family Medicine Physician	011390	AZ
3	208M00000X	Hospitalist Physician	011390	AZ
4	208M00000X	Hospitalist Physician	5101028352	MI

General Provider Information

NPI Number	:	1194342360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUGUSTE SHIMWA NIYIBIZI DO

Provider Business Mailing Address
First Line	:	1 UNIVERSITY OF NEW MEXICO
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-0001
Country	:	US
Telephone Number	:	505-272-2321
Fax Number	:

Provider Business Practice Location Address
First Line	:	3833 E THOMAS RD STE A2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7523
Country	:	US
Telephone Number	:	602-671-7066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	08/13/2025

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