Provider Demographics
NPI:1992903355
Name:KARIM, SHABANA C (MD)
Entity type:Individual
Prefix:DR
First Name:SHABANA
Middle Name:C
Last Name:KARIM
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:PO BOX 4577
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-4577
Mailing Address - Country:US
Mailing Address - Phone:662-332-8848
Mailing Address - Fax:662-332-8854
Practice Address - Street 1:1502 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7219
Practice Address - Country:US
Practice Address - Phone:662-332-8848
Practice Address - Fax:662-332-8854
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02273838Medicaid
MS02273838Medicaid