Provider Demographics
NPI:1578529392
Name:SHAHIN, SALEM SHEHADEH (MD)
Entity Type:Individual
Prefix:
First Name:SALEM
Middle Name:SHEHADEH
Last Name:SHAHIN
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 1:1219 KNOLL ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801
Mailing Address - Country:US
Mailing Address - Phone:701-572-0127
Mailing Address - Fax:701-572-4472
Practice Address - Street 1:1219 KNOLL ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801
Practice Address - Country:US
Practice Address - Phone:701-572-0127
Practice Address - Fax:701-572-4472
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4571208800000X
MT4737208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13783Medicaid
MT0000082800OtherBCBS MT
D26285Medicare UPIN
MT000082172Medicare ID - Type Unspecified
MT0000082800OtherBCBS MT