MEDICARE: DR. IBRAHIM S SHAMIEH 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	207RG0100X	Gastroenterology Physician	4301064684	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P89032	OTHER	MI	BCN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0988839	OTHER	MI	HEALTH PLUS
4	3500670651	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1629026463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IBRAHIM S SHAMIEH MD

Provider Business Mailing Address
First Line	:	PO BOX 125
Second Line	:
City	:	STANDISH
State	:	MI
Zip	:	48658
Country	:	US
Telephone Number	:	989-846-3500
Fax Number	:	989-846-3462

Provider Business Practice Location Address
First Line	:	805 WEST CEDAR STREET
Second Line	:
City	:	STANDISH
State	:	MI
Zip	:	48658
Country	:	US
Telephone Number	:	989-846-3500
Fax Number	:	989-846-3462

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/04/2010

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