Provider Demographics
NPI:1992024020
Name:PACKIR-MOHIDEEN-SHUMS, ASIF SHAMEEM (MD)
Entity Type:Individual
Prefix:
First Name:ASIF
Middle Name:SHAMEEM
Last Name:PACKIR-MOHIDEEN-SHUMS
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 1:36475 FIVE MILE ROAD
Mailing Address - Street 2:ST. MARY MERCY HOSPITAL
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-655-2727
Mailing Address - Fax:734-655-8430
Practice Address - Street 1:36475 FIVE MILE ROAD
Practice Address - Street 2:ST. MARY MERCY HOSPITAL
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-655-2727
Practice Address - Fax:734-655-8430
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program