MEDICARE: NASIR A SHAMSI 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	208000000X	Pediatrics Physician	01043702	IN

General Provider Information

NPI Number	:	1881782910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASIR A SHAMSI M.D

Provider Business Mailing Address
First Line	:	6933 KENNEDY AVE
Second Line	:	SUITE C
City	:	HAMMOND
State	:	IN
Zip	:	46323-2210
Country	:	US
Telephone Number	:	219-844-2256
Fax Number	:	219-844-0823

Provider Business Practice Location Address
First Line	:	6933 KENNEDY AVE
Second Line	:	SUITE C
City	:	HAMMOND
State	:	IN
Zip	:	46323-2210
Country	:	US
Telephone Number	:	219-844-2256
Fax Number	:	219-844-0823

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/09/2007

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