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NPI Code Detail

MEDICARE: DR. SHUJA RASOOL M.D

MEDICARE: DR. SHUJA RASOOL 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
1207RC0000XCardiovascular Disease PhysicianE-7474AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588841340
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHUJA RASOOL M.D
Provider Business Mailing Address
First Line : 2205 W MAIN ST
Second Line :
City : RUSSELLVILLE
State : AR
Zip : 72801-2759
Country : US
Telephone Number : 479-968-4311
Fax Number : 479-968-4399
Provider Business Practice Location Address
First Line : 2205 W MAIN ST
Second Line :
City : RUSSELLVILLE
State : AR
Zip : 72801-2759
Country : US
Telephone Number : 479-968-4311
Fax Number : 479-968-4399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2008
Last Update Date : 08/22/2023

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