Provider Demographics
NPI:1528053824
Name:ABU SHAMAT, ABDEL FARID (MD)
Entity type:Individual
Prefix:
First Name:ABDEL
Middle Name:FARID
Last Name:ABU SHAMAT
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 1:333 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5887
Mailing Address - Country:US
Mailing Address - Phone:337-494-7090
Mailing Address - Fax:337-494-7040
Practice Address - Street 1:333 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:SUITE 140
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5887
Practice Address - Country:US
Practice Address - Phone:337-494-7090
Practice Address - Fax:337-494-7040
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11617R207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00103040OtherRR MEDICARE
LA1679232Medicaid
LA1679232Medicaid
G25692Medicare UPIN
LA5W776D048Medicare PIN