Healthcare Provider Details

I. General information

NPI: 1629026463
Provider Name (Legal Business Name): IBRAHIM S SHAMIEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 WEST CEDAR STREET
STANDISH MI
48658
US

IV. Provider business mailing address

PO BOX 125
STANDISH MI
48658
US

V. Phone/Fax

Practice location:
  • Phone: 989-846-3500
  • Fax: 989-846-3462
Mailing address:
  • Phone: 989-846-3500
  • Fax: 989-846-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301064684
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: