MEDICARE: SHOHEI SOWID-SHIMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	008570	AZ

General Provider Information

NPI Number	:	1164963591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOHEI SOWID-SHIMA

Provider Business Mailing Address
First Line	:	6860 E SUNRISE DR STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-0733
Country	:	US
Telephone Number	:	520-694-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	6860 E SUNRISE DR STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-0733
Country	:	US
Telephone Number	:	520-694-8888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2017
Last Update Date	:	08/21/2020

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Directions to “ SHOHEI SOWID-SHIMA ” Practice Location

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