Basic Information
| Provider Information | |||||||||
| NPI: | 1902097439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAFIQUE | ||||||||
| FirstName: | SHAHZAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 557 | ||||||||
| Address2: | 1600 E EVERGREEN | ||||||||
| City: | CAMERON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644290557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166322101 | ||||||||
| FaxNumber: | 8166493383 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 E EVERGREEN ST. | ||||||||
| Address2: | CAMERON REGIONAL MEDICAL CENTER | ||||||||
| City: | CAMERON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166493203 | ||||||||
| FaxNumber: | 8166493383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2007 | ||||||||
| LastUpdateDate: | 09/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 04-32498 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 2009009275 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.