Provider Demographics
NPI:1053579094
Name:SHAMI, SALWAT (MD)
Entity type:Individual
Prefix:
First Name:SALWAT
Middle Name:
Last Name:SHAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W HOSPITAL DRIVE
Mailing Address - Street 2:STE D
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251
Mailing Address - Country:US
Mailing Address - Phone:573-642-5338
Mailing Address - Fax:573-642-9224
Practice Address - Street 1:850 W HOSPITAL DRIVE
Practice Address - Street 2:STE D
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251
Practice Address - Country:US
Practice Address - Phone:573-642-5338
Practice Address - Fax:573-642-9224
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009018164207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO105359094Medicaid