Healthcare Provider Details

I. General information

NPI: 1962580852
Provider Name (Legal Business Name): SHAIKH B. MATIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

IV. Provider business mailing address

2740 HERNDON AVE
CLOVIS CA
93611-6813
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-4500
  • Fax:
Mailing address:
  • Phone: 559-299-4264
  • Fax: 559-299-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA47729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: