1326238593 NPI number — DR. IMRAN SHAFIQUE M.D

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326238593 NPI number — DR. IMRAN SHAFIQUE M.D

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SHAFIQUE

Provider First Name:

IMRAN

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1326238593

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/27/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

600 E TAYLOR ST

Provider Second Line Business Mailing Address:

SUITE 103

Provider Business Mailing Address City Name:

SHERMAN

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

75090-2881

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

903-893-7170

Provider Business Mailing Address Fax Number:

903-893-4372

Provider First Line Business Practice Location Address:

600 E TAYLOR ST

Provider Second Line Business Practice Location Address:

SUITE 103

Provider Business Practice Location Address City Name:

SHERMAN

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

75090-2881

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

903-893-7170

Provider Business Practice Location Address Fax Number:

903-893-4372

Provider Enumeration Date:

07/25/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 390200000X , with the licence number:  4301087796 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: 4301087796 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RN0300X , with the licence number: P9456 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207RN0300X , with the licence number: 30932 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 1102514562 . This is a "BCBSM INDIVIDUAL PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 1326238593 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: P01474081 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: OB56031 . This is a "BCBSM GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 339185601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: P01474183 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
• Identifier: 200579280A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
• Identifier: OB56031 . This is a "MEDICARE GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".