Provider Demographics
NPI:1326238593
Name:SHAFIQUE, IMRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:
Last Name:SHAFIQUE
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 1:600 E TAYLOR ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2881
Mailing Address - Country:US
Mailing Address - Phone:903-893-7170
Mailing Address - Fax:903-893-4372
Practice Address - Street 1:600 E TAYLOR ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2881
Practice Address - Country:US
Practice Address - Phone:903-893-7170
Practice Address - Fax:903-893-4372
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087796390200000X, 207R00000X
TXP9456207RN0300X
OK30932207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102514562OtherBCBSM INDIVIDUAL PIN
MI1326238593Medicaid
TXP01474081OtherRAILROAD MEDICARE
MIOB56031OtherBCBSM GROUP
TX339185601Medicaid
OKP01474183OtherRAILROAD MEDICARE
OK200579280AMedicaid
MIOB56031OtherMEDICARE GROUP
OKP01474183OtherRAILROAD MEDICARE
MI1326238593Medicaid
TXP01474081OtherRAILROAD MEDICARE