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1356657977

NPI Code Detail

MEDICARE: DR. SHARIQ SHAMIM M.D.

MEDICARE: DR. SHARIQ SHAMIM M.D.

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	207RC0000X	Cardiovascular Disease Physician	MD2018-0100	NM
2	207RC0000X	Cardiovascular Disease Physician	036154289	IL
3	207RC0000X	Cardiovascular Disease Physician	2017000105	MO
4	207RI0011X	Interventional Cardiology Physician	MD2018-0100	NM
5	207RI0011X	Interventional Cardiology Physician	036154289	IL
6	207RI0011X	Interventional Cardiology Physician	2017000105	MO

General Provider Information

NPI Number	:	1356657977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARIQ SHAMIM M.D.

Provider Business Mailing Address
First Line	:	3550 MCKELVEY RD
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2527
Country	:	US
Telephone Number	:	314-741-0911
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 MCKELVEY RD
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2527
Country	:	US
Telephone Number	:	314-741-0911
Fax Number	:

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

Provider Enumeration Date	:	08/19/2010
Last Update Date	:	12/06/2021

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Directions to “ DR. SHARIQ SHAMIM M.D.” Practice Location

Language	Start Address	Practice Location

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