Provider Demographics
NPI:1639551880
Name:SHAHEEN, PHILIP JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JEFFREY
Last Name:SHAHEEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:615 S NEW BALLAS RD
Mailing Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8221
Mailing Address - Country:US
Mailing Address - Phone:314-251-7069
Mailing Address - Fax:314-251-7071
Practice Address - Street 1:11900 E 12 MILE RD STE 300
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3491
Practice Address - Country:US
Practice Address - Phone:248-465-5140
Practice Address - Fax:586-738-9517
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2024-08-20
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Provider Licenses
StateLicense IDTaxonomies
MO2015020396207X00000X
NV21959207XX0004X
CA176232207XX0004X
MI4301509590207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery