Provider Demographics
NPI:1215249743
Name:DR SAMUEL H SHAHEEN PC
Entity type:Organization
Organization Name:DR SAMUEL H SHAHEEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-777-0930
Mailing Address - Street 1:1100 S WASHINGTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2557
Mailing Address - Country:US
Mailing Address - Phone:989-777-0930
Mailing Address - Fax:
Practice Address - Street 1:1100 S WASHINGTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2557
Practice Address - Country:US
Practice Address - Phone:989-777-0930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1215271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty