Provider Demographics
NPI:1649616459
Name:MUSA, SHAMSIDEEN OLAMITUNDE (MD)
Entity type:Individual
Prefix:DR
First Name:SHAMSIDEEN
Middle Name:OLAMITUNDE
Last Name:MUSA
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 1:4001 DALE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5444
Mailing Address - Country:US
Mailing Address - Phone:907-770-1152
Mailing Address - Fax:907-770-1153
Practice Address - Street 1:4001 DALE ST STE 105
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5444
Practice Address - Country:US
Practice Address - Phone:907-770-1152
Practice Address - Fax:907-770-1153
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4477207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX375626402OtherCSHCN
TX375626401Medicaid