Provider Demographics
NPI:1992985386
Name:SHAHID, MUHAMMAD (MD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:
Last Name:SHAHID
Suffix:
Gender:M
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 990
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-0990
Mailing Address - Country:US
Mailing Address - Phone:985-747-0444
Mailing Address - Fax:985-747-0480
Practice Address - Street 1:309 WALNUT ST
Practice Address - Street 2:SUITE C
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2055
Practice Address - Country:US
Practice Address - Phone:985-747-0444
Practice Address - Fax:985-747-0480
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12656R207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG91246Medicare UPIN