Provider Demographics
NPI:1629026463
Name:SHAMIEH, IBRAHIM S (MD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:S
Last Name:SHAMIEH
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:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658
Mailing Address - Country:US
Mailing Address - Phone:989-846-3500
Mailing Address - Fax:989-846-3462
Practice Address - Street 1:805 WEST CEDAR STREET
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658
Practice Address - Country:US
Practice Address - Phone:989-846-3500
Practice Address - Fax:989-846-3462
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064684207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP89032OtherBCN
MI4255957Medicaid
MI0988839OtherHEALTH PLUS
MI3500670651OtherBCBSM
MI4255957Medicaid
MI0988839OtherHEALTH PLUS