Basic Information
| Provider Information | |||||||||
| NPI: | 1073571733 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAIKH | ||||||||
| FirstName: | GHULAM | ||||||||
| MiddleName: | MURTAZA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 171 MAST DR | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275296718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197710503 | ||||||||
| FaxNumber: | 9197710504 | ||||||||
| Practice Location | |||||||||
| Address1: | 171 MAST DR | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275296718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197710503 | ||||||||
| FaxNumber: | 9197710504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 12/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9501091 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 75303 | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 8975303 | 05 | NC | MEDICAID |