Provider Demographics
NPI:1770937518
Name:MAHMUD, SHAWN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:MAHMUD
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Gender:M
Credentials:MD, PHD
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Other - Last Name:
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Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:M663 RIVERSIDE EAST BLDG, CDC 8952F
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-624-8903
Mailing Address - Fax:
Practice Address - Street 1:2414 S 7TH ST
Practice Address - Street 2:AO-10 ACADEMIC OFFICE BUILDING
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1435
Practice Address - Country:US
Practice Address - Phone:612-626-4598
Practice Address - Fax:612-626-6905
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN663892080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1770937518Medicaid