Provider Demographics
NPI:1578762548
Name:SHAHIRA, ERAM (MD)
Entity Type:Individual
Prefix:
First Name:ERAM
Middle Name:
Last Name:SHAHIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BROADWAY N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3641
Mailing Address - Country:US
Mailing Address - Phone:701-234-2731
Mailing Address - Fax:701-234-2158
Practice Address - Street 1:801 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-3641
Practice Address - Country:US
Practice Address - Phone:701-234-2731
Practice Address - Fax:701-234-2158
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10650207R00000X, 207RN0300X
NDPT 10650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14291Medicaid
ND81356Medicaid
NDN712745Medicare PIN
NDN716912Medicare PIN
MNH400225678Medicare PIN