MEDICARE: DR. REHAN SHAFIQUE 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	390200000X	Student in an Organized Health Care Education/Training Program

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1031395661	OTHER	TN	MEDICARE PTAN

General Provider Information

NPI Number	:	1851510143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REHAN SHAFIQUE M.D.

Provider Business Mailing Address
First Line	:	3950 NEW COVINGTON PIKE
Second Line	:	SUITE 300
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2591
Country	:	US
Telephone Number	:	901-382-5256
Fax Number	:	901-382-3731

Provider Business Practice Location Address
First Line	:	3950 NEW COVINGTON PIKE
Second Line	:	SUITE 300
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2591
Country	:	US
Telephone Number	:	901-382-5256
Fax Number	:	901-382-3731

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	10/04/2011

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