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General NPI Number Information
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NPI Number | 1972851608
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Entity Type | Organization
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Legal Business Name | FAMILY GASTROENTEROLOGY P L L C
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 805 W CEDAR ST
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City | STANDISH
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State | MI
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Zip | 48658-9526
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Country | US
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Telephone | 989-846-3555
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Fax | 989-846-3462
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Provider Business Mailing Address
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Address Line | PO BOX 125
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City | STANDISH
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State | MI
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Zip | 48658-0125
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Country | US
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Telephone | 989-846-3500
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Fax | 989-846-3462
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. IBRAHIM S SHAMIEH
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Credential | MD
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Telephone | 989-846-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301064684
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License Number State | MI
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