Provider Demographics
NPI:1902097439
Name:SHAFIQUE, SHAHZAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHZAD
Middle Name:
Last Name:SHAFIQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:1600 E EVERGREEN
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-0557
Mailing Address - Country:US
Mailing Address - Phone:913-626-0568
Mailing Address - Fax:816-649-3383
Practice Address - Street 1:1600 E EVERGREEN ST.
Practice Address - Street 2:CAMERON REGIONAL MEDICAL CENTER
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429
Practice Address - Country:US
Practice Address - Phone:913-626-0568
Practice Address - Fax:816-649-3383
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32498207RN0300X
MO2009009275207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology