MEDICARE: MINA KARAM SHAMMAS

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1720878259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA KARAM SHAMMAS

Provider Business Mailing Address
First Line	:	49464 GRACECHURCH RD
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48044-1528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	49464 GRACECHURCH RD
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48044-1528
Country	:	US
Telephone Number	:	586-805-8850
Fax Number	:

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

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	05/08/2025

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Directions to “ MINA KARAM SHAMMAS ” Practice Location

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