Healthcare Provider Details

I. General information

NPI: 1619540622
Provider Name (Legal Business Name): MUHAMMAD SHOAIB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date: 03/31/2023
Reactivation Date: 05/11/2023

III. Provider practice location address

330 E BELTLINE AVE NE
GRAND RAPIDS MI
49506-1267
US

IV. Provider business mailing address

330 E BELTLINE AVE NE
GRAND RAPIDS MI
49506-1267
US

V. Phone/Fax

Practice location:
  • Phone: 616-752-6235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301511028
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: