Healthcare Provider Details

I. General information

NPI: 1619537255
Provider Name (Legal Business Name): MUHAMMED SHAROZ SHAMIM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 08/21/2023
Certification Date: 08/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S SAGINAW ST
FLINT MI
48507-2677
US

IV. Provider business mailing address

48998 IVYBRIDGE WAY
CANTON MI
48187-2577
US

V. Phone/Fax

Practice location:
  • Phone: 810-275-9333
  • Fax:
Mailing address:
  • Phone: 706-992-5686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901400491
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901400491
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: