Provider Demographics
NPI:1851510143
Name:SHAFIQUE, REHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:REHAN
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 1:3950 NEW COVINGTON PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2591
Mailing Address - Country:US
Mailing Address - Phone:901-382-5256
Mailing Address - Fax:901-382-3731
Practice Address - Street 1:3950 NEW COVINGTON PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2591
Practice Address - Country:US
Practice Address - Phone:901-382-5256
Practice Address - Fax:901-382-3731
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1031395661OtherMEDICARE PTAN