Provider Demographics
NPI:1619942596
Name:MOHEYUDDIN, SHAMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAMAS
Middle Name:
Last Name:MOHEYUDDIN
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 1:3120 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5131
Mailing Address - Country:US
Mailing Address - Phone:734-677-6000
Mailing Address - Fax:734-677-2422
Practice Address - Street 1:3120 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5131
Practice Address - Country:US
Practice Address - Phone:734-677-6000
Practice Address - Fax:734-677-2422
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085148208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4758007Medicaid
MI4758007Medicaid
MION56210Medicare ID - Type Unspecified
MIOH16040021Medicare PIN