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NPI Code Detail

MEDICARE: DR. MOHAMED BASHAR ABOU SHALA MD

MEDICARE: DR. MOHAMED BASHAR ABOU SHALA 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
1207RC0000XCardiovascular Disease Physician26593TN
2207RI0011XInterventional Cardiology Physician26593TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00378331OTHERTNRAIL ROAD MEDICARE
4P00393920OTHERMSRAIL ROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14146206OTHERTNBCBS
35188055OTHERTNAETNA
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6000000015934OTHERTNTLC
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
802100041401OTHERQUALCHOICE
997426OTHERARBCBS

General Provider Information

NPI Number : 1841277308
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MOHAMED BASHAR ABOU SHALA MD
Provider Business Mailing Address
First Line : 6799 GREAT OAKS RD
Second Line :
City : MEMPHIS
State : TN
Zip : 38138-2588
Country : US
Telephone Number : 901-751-0405
Fax Number : 901-751-9694
Provider Business Practice Location Address
First Line : 6799 GREAT OAKS RD
Second Line :
City : MEMPHIS
State : TN
Zip : 38138-2588
Country : US
Telephone Number : 901-751-0405
Fax Number : 901-751-9694
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2005
Last Update Date : 02/14/2014

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