Provider Demographics
NPI:1508432196
Name:SHAMEELA BEGUM, UNKNOWN (MD)
Entity type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:SHAMEELA BEGUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ACACIA ST,
Mailing Address - Street 2:
Mailing Address - City:SCOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:96203
Mailing Address - Country:US
Mailing Address - Phone:209-944-5550
Mailing Address - Fax:
Practice Address - Street 1:6701 W OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA193832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program