Provider Demographics
NPI:1972857043
Name:SHAQFEH, MAHMOUD MOHD AYMAN (MBBS)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:MOHD AYMAN
Last Name:SHAQFEH
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 TUURI PL
Mailing Address - Street 2:APT. 101
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2481
Mailing Address - Country:US
Mailing Address - Phone:810-341-2040
Mailing Address - Fax:
Practice Address - Street 1:1 HURLEY PLZ # 3W
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-257-9841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100613207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics