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General NPI Number Information
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NPI Number | 1568995785
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Entity Type | Organization
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Legal Business Name | SOUTHLAKE INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 928 MARY ELLEN DR
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City | CROWN POINT
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State | IN
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Zip | 46307-8998
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Country | US
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Telephone | 219-252-0309
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Fax |
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Provider Business Mailing Address
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Address Line | 928 MARY ELLEN DR
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City | CROWN POINT
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State | IN
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Zip | 46307-8998
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Country | US
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Telephone | 219-252-0309
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHOAIB H RASHEED
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Credential | MD
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Telephone | 219-252-0309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01066300
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License Number State | IN
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