Provider Demographics
NPI:1063438018
Name:CHOWDHURY, SHOAIB AHMED (MD)
Entity type:Individual
Prefix:DR
First Name:SHOAIB
Middle Name:AHMED
Last Name:CHOWDHURY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8795 PINE RIDGE DR
Mailing Address - Street 2:STE B
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-9720
Mailing Address - Country:US
Mailing Address - Phone:231-779-9960
Mailing Address - Fax:231-779-8945
Practice Address - Street 1:8795 PINE RIDGE DR
Practice Address - Street 2:STE B
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-9720
Practice Address - Country:US
Practice Address - Phone:231-779-9960
Practice Address - Fax:231-779-8945
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301078654207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI433661610Medicaid
MI1108300652OtherBLUE CROSS
MI110245345OtherRAILROAD MEDICARE
MI0N35020002Medicare PIN