Basic Information
| Provider Information | |||||||||
| NPI: | 1629026463 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAMIEH | ||||||||
| FirstName: | IBRAHIM | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 125 | ||||||||
| Address2: | |||||||||
| City: | STANDISH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898463500 | ||||||||
| FaxNumber: | 9898463462 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 WEST CEDAR STREET | ||||||||
| Address2: | |||||||||
| City: | STANDISH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898463500 | ||||||||
| FaxNumber: | 9898463462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 08/04/2010 | ||||||||
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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 | 207RG0100X | 4301064684 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | P89032 | 01 | MI | BCN | OTHER | 4255957 | 05 | MI | MEDICAID | 0988839 | 01 | MI | HEALTH PLUS | OTHER | 3500670651 | 01 | MI | BCBSM | OTHER |