MEDICARE: DR. FAYEK NICHOLAS SHAMMA 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
1	207VE0102X	Reproductive Endocrinology Physician	FN059015	MI
2	207VE0102X	Reproductive Endocrinology Physician	35.065228	OH
3	207V00000X	Obstetrics & Gynecology Physician	35065228	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35065228	OTHER	OH	OHIO LICENSE #
2	036410841	OTHER	IL	ILLINOIS LICENSE #

General Provider Information

NPI Number	:	1962408161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAYEK NICHOLAS SHAMMA MD

Provider Business Mailing Address
First Line	:	37000 WOODWARD AVE STE 350
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-0944
Country	:	US
Telephone Number	:	248-952-9600
Fax Number	:	248-844-2538

Provider Business Practice Location Address
First Line	:	37000 WOODWARD AVE STE 350
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-0944
Country	:	US
Telephone Number	:	248-952-9600
Fax Number	:	248-844-2538

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/25/2022

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