Provider Demographics
NPI:1881894582
Name:SHAMIM, QURRAT UL AIN (MD)
Entity type:Individual
Prefix:
First Name:QURRAT UL AIN
Middle Name:
Last Name:SHAMIM
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 1:5896 S APPLEWOOD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-6014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 W 4TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2447
Practice Address - Country:US
Practice Address - Phone:931-783-2902
Practice Address - Fax:931-783-2219
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51989207RN0300X
MO2023050603207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007499Medicaid
TN6023511OtherBCBS
TN7100425380Medicaid
TN6023511OtherBCBS