Provider Demographics
NPI:1740210194
Name:CHEEMA, FAISAL NAWAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:NAWAZ
Last Name:CHEEMA
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 1:201 PROMENADE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-3255
Mailing Address - Country:US
Mailing Address - Phone:513-309-1596
Mailing Address - Fax:
Practice Address - Street 1:201 PROMENADE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-3255
Practice Address - Country:US
Practice Address - Phone:513-309-1596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-086926207R00000X, 208M00000X
TXN2028207RG0300X, 207R00000X
LAMD.204017207R00000X
OH35.086926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI54455Medicare UPIN