MEDICARE: HUSAM SHADID 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	208M00000X	Hospitalist Physician	U4005	TX
2	207R00000X	Internal Medicine Physician	U4005	TX
3	207RC0000X	Cardiovascular Disease Physician	4301513352	MI

General Provider Information

NPI Number	:	1992366801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUSAM SHADID MD

Provider Business Mailing Address
First Line	:	1 FORD PL STE 3A
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3450
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 N EAST AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1753
Country	:	US
Telephone Number	:	517-205-4800
Fax Number	:

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

Provider Enumeration Date	:	06/23/2019
Last Update Date	:	06/11/2026

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Directions to “ HUSAM SHADID MD” Practice Location

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