Healthcare Provider Details

I. General information

NPI: 1811316458
Provider Name (Legal Business Name): SHIMA GHAVIMI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S HACKETT RD
WATERLOO IA
50701
US

IV. Provider business mailing address

1015 S HACKETT RD
WATERLOO IA
50701-3500
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-5990
  • Fax:
Mailing address:
  • Phone: 319-234-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number29355
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberMD-50743
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number25MA10563700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29355
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA10563700
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA10563700
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number29355
License Number StateWV
# 8
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD-50743
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: