Southlake Internal Medicine LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

01066300 Issued in IN

Legal business name

SOUTHLAKE INTERNAL MEDICINE LLC

Practice address

928 Mary Ellen Dr
Crown Point, IN 46307-8998

Phone

(219) 252-0309

NPI assigned

Apr 5, 2017

Last updated

Apr 5, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shoaib H Rasheed, MD

Title

Owner

Phone

(219) 252-0309

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491350400000",
    "number": "1568995785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 MARY ELLEN DR",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078998",
            "telephone_number": "219-252-0309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 MARY ELLEN DR",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078998",
            "telephone_number": "219-252-0309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE INTERNAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-05",
        "last_updated": "2017-04-05",
        "status": "A",
        "authorized_official_last_name": "RASHEED",
        "authorized_official_first_name": "SHOAIB",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-252-0309",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "IN",
            "license": "01066300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Crown Point, IN
• Providers in Crown Point, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.