Provider Demographics
NPI:1376570648
Name:SHAFIQ, SALMAN (MD)
Entity Type:Individual
Prefix:
First Name:SALMAN
Middle Name:
Last Name:SHAFIQ
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 1:3841 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-6206
Mailing Address - Country:US
Mailing Address - Phone:651-653-0040
Mailing Address - Fax:651-241-2793
Practice Address - Street 1:333 SMITH AVE N
Practice Address - Street 2:SUITE 4314A
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2344
Practice Address - Country:US
Practice Address - Phone:651-241-8451
Practice Address - Fax:651-241-2793
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine