Physician Compare National (NPI:1104139401)

HEALTHCARE PROVIDER: FAISAL MOHIUDDIN SHAH M.D

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1104139401
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5092944207
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140211001459
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHAH
	Individual professional last name
Provider First Name	FAISAL
	Individual professional first name
Provider Middle Name	MOHUDDIN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	EMERGENCY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	EMERGENCY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	28505 FORD RD
	Group Practice or individual's line 1 address
City	GARDEN CITY
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	481352843
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230092
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HENRY FORD ALLEGIANCE HEALTH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	230020
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BEAUMONT HOSPITAL - DEARBORN
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	230216
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MCLAREN PORT HURON
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y