Healthcare Provider Details

I. General information

NPI: 1184816829
Provider Name (Legal Business Name): SHUJA AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 10/27/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE, 2 SHORB TOWER
MEMPHIS TN
38104
US

IV. Provider business mailing address

PO BOX 27892
BELFAST ME
04915-2030
US

V. Phone/Fax

Practice location:
  • Phone: 901-478-0900
  • Fax: 901-266-6415
Mailing address:
  • Phone: 901-758-9900
  • Fax: 901-752-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number036147260
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: