Provider Demographics
NPI:1205104080
Name:SALEM S SHAHIN MD PC
Entity type:Organization
Organization Name:SALEM S SHAHIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-572-0127
Mailing Address - Street 1:1219 KNOLL ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3234
Mailing Address - Country:US
Mailing Address - Phone:701-572-0127
Mailing Address - Fax:701-572-4472
Practice Address - Street 1:1219 KNOLL ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3234
Practice Address - Country:US
Practice Address - Phone:701-572-0127
Practice Address - Fax:701-572-4472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4571208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13783Medicaid
ND13783Medicaid