MEDICARE: NUHA SHASH-BARAZANJI MD

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	208000000X	Pediatrics Physician	30258	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	32017	OTHER	IA	WELLMARK BLUE SHIELD

General Provider Information

NPI Number	:	1205945326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NUHA SHASH-BARAZANJI MD

Provider Business Mailing Address
First Line	:	PO BOX 1475
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50306-1475
Country	:	US
Telephone Number	:	515-222-7337
Fax Number	:	515-222-7340

Provider Business Practice Location Address
First Line	:	1601 NW 114TH ST
Second Line	:	SUITE 345
City	:	DES MOINES
State	:	IA
Zip	:	50325-7007
Country	:	US
Telephone Number	:	515-222-7337
Fax Number	:	515-222-7340

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/16/2009

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Directions to “ NUHA SHASH-BARAZANJI MD” Practice Location

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