MEDICARE: ADEL N SHENOUDA MD

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	207RN0300X	Nephrology Physician	9141	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518963990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEL N SHENOUDA MD

Provider Business Mailing Address
First Line	:	979 E 3RD ST
Second Line	:	STE B1111
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2136
Country	:	US
Telephone Number	:	423-778-7036
Fax Number	:	423-778-7832

Provider Business Practice Location Address
First Line	:	979 E 3RD ST
Second Line	:	STE B1111
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2136
Country	:	US
Telephone Number	:	423-778-7036
Fax Number	:	423-778-7832

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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