Provider Demographics
NPI:1629567912
Name:SHAFIQUE, UMAIR (MD)
Entity Type:Individual
Prefix:
First Name:UMAIR
Middle Name:
Last Name:SHAFIQUE
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 1:8006 HIGHWAY 613
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-8200
Mailing Address - Country:US
Mailing Address - Phone:228-475-1166
Mailing Address - Fax:
Practice Address - Street 1:8006 HIGHWAY 613
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39562-8200
Practice Address - Country:US
Practice Address - Phone:228-475-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS29328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine