Provider Demographics
NPI:1851898399
Name:ALAM, SHAHDEEN SHAMS (DO)
Entity Type:Individual
Prefix:
First Name:SHAHDEEN
Middle Name:SHAMS
Last Name:ALAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1948 AL HIGHWAY 157 STE 450
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0643
Mailing Address - Country:US
Mailing Address - Phone:256-735-5075
Mailing Address - Fax:256-735-5076
Practice Address - Street 1:1948 AL HIGHWAY 157 STE 450
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0643
Practice Address - Country:US
Practice Address - Phone:256-735-5075
Practice Address - Fax:256-735-5076
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.2098207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL273155Medicaid