Provider Demographics
NPI:1255331831
Name:MUNIM, SHAHIDA RAHMAN (MD)
Entity Type:Individual
Prefix:
First Name:SHAHIDA
Middle Name:RAHMAN
Last Name:MUNIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAHIDA
Other - Middle Name:
Other - Last Name:RAHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7200 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4710
Mailing Address - Country:US
Mailing Address - Phone:414-543-1441
Mailing Address - Fax:414-543-1521
Practice Address - Street 1:7200 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4710
Practice Address - Country:US
Practice Address - Phone:414-543-1441
Practice Address - Fax:414-543-1521
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38582207RS0012X, 207R00000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI110237344OtherRAIL ROAD MEDICARE
WI32321700Medicaid
G48996Medicare UPIN
WI000202719Medicare PIN