Family Gastroenterology P L L C
Organization Active NPI Gastroenterology Physician · Standish, MI
NPI 1972851608 · NPPES record last updated Aug 28, 2012
Key facts
- NPI
- 1972851608
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Gastroenterology Physician 207RG0100X
- License
- 4301064684 (MI)
- Legal business name
- FAMILY GASTROENTEROLOGY P L L C
- Practice address
- 805 W Cedar St
Standish, MI 48658-9526 - Phone
- (989) 846-3555
- Fax
- (989) 846-3462
- NPI assigned
- Aug 28, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Ibrahim S Shamieh, MD
- Title
- Owner/Physician
- Phone
- (989) 846-3500
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121026000571 | MI | Part B Supplier - Clinic/Group Practice | 2466602487 |
Receives reassigned benefits from 1 practitioner Practice locations: Standish, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician |
207RG0100X | 4301064684 | MI | Yes |
Addresses
Primary practice location
805 W Cedar St
Standish, MI 48658-9526
Mailing address
PO Box 125
Standish, MI 48658-0125
Phone (989) 846-3500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0067065 | Other | MI | BLUE CARE NETWORK |
| 3500670651 | Other | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN |
| 1629026463 | Other | MI | INDIVIDUAL NPI |
| 0988839 | Other | MI | HEALTH PLUS OF MICHIGAN |
| 4255957 | Medicaid | MI |
Other providers in Standish, MI
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- Andrew Raymond Dwan
- Mallori Ann Dzurka
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- Emily Filhart
- Luke Finkbeiner
- Selina Noel Flanscha
- Rey A Franco
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All providers in Standish, MI · Gastroenterology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.