MEDICARE: MR. SHAMAS MOHEYUDDIN 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	208VP0014X	Interventional Pain Medicine Physician	4301085148	MI
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	4301085148	MI

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

General Provider Information

NPI Number	:	1619942596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAMAS MOHEYUDDIN M.D.

Provider Business Mailing Address
First Line	:	3120 PROFESSIONAL DR
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-5131
Country	:	US
Telephone Number	:	734-677-6000
Fax Number	:	734-677-2422

Provider Business Practice Location Address
First Line	:	3120 PROFESSIONAL DR
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-5131
Country	:	US
Telephone Number	:	734-677-6000
Fax Number	:	734-677-2422

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/03/2013

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