Provider Demographics
NPI:1972851608
Name:FAMILY GASTROENTEROLOGY P L L C
Entity Type:Organization
Organization Name:FAMILY GASTROENTEROLOGY P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAMIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-846-3500
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-0125
Mailing Address - Country:US
Mailing Address - Phone:989-846-3500
Mailing Address - Fax:989-846-3462
Practice Address - Street 1:805 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9526
Practice Address - Country:US
Practice Address - Phone:989-846-3555
Practice Address - Fax:989-846-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064684207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0067065OtherBLUE CARE NETWORK
MI3500670651OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI1629026463OtherINDIVIDUAL NPI
MI0988839OtherHEALTH PLUS OF MICHIGAN
MI4255957Medicaid
MI0988839OtherHEALTH PLUS OF MICHIGAN
MI0N18770Medicare PIN