MEDICARE: UMAIR SHAFIQUE M.D.

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	207R00000X	Internal Medicine Physician	29328	MS

General Provider Information

NPI Number	:	1629567912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UMAIR SHAFIQUE M.D.

Provider Business Mailing Address
First Line	:	8006 HIGHWAY 613
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39562-8200
Country	:	US
Telephone Number	:	228-475-1166
Fax Number	:

Provider Business Practice Location Address
First Line	:	8006 HIGHWAY 613
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39562-8200
Country	:	US
Telephone Number	:	228-475-1166
Fax Number	:

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

Provider Enumeration Date	:	05/02/2018
Last Update Date	:	06/18/2023

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