Provider Demographics
NPI: | 1083611974 |
---|---|
Name: | CHEEMA, SHAFIQ UR- REHMAN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SHAFIQ |
Middle Name: | UR- REHMAN |
Last Name: | CHEEMA |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2309 E SAUNDERS ST |
Mailing Address - Street 2: | SUITE 100 |
Mailing Address - City: | LAREDO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78041-5434 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 956-723-4673 |
Mailing Address - Fax: | 956-723-3133 |
Practice Address - Street 1: | 2309 E SAUNDERS ST |
Practice Address - Street 2: | SUITE 100 |
Practice Address - City: | LAREDO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78041-5434 |
Practice Address - Country: | US |
Practice Address - Phone: | 956-723-4673 |
Practice Address - Fax: | 956-723-3133 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-07-07 |
Last Update Date: | 2013-04-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | L8013 | 207RN0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 190612505 | Medicaid | |
TX | 1083611974 | Other | MEDICARE RAILROAD |
TX | 1083611974 | Other | MEDICARE RAILROAD |
TX | 190612505 | Medicaid | |
TX | TXB119653 | Medicare PIN |