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Organization
SHAMSUL ALAM MD PA
Active
Organization
SHAMSUL ALAM MD PA
Active
Other names
The Kidney Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAMSUL ALAM M.D. (PRESIDENT)
(479) 271-9393
Entity
Organization
Contact information
Practice address
2618 SE J ST, SUITE#4, BENTONVILLE, AR 72712-3767
(479) 271-9393
(479) 271-9393
Mailing address
PO BOX 1037, BENTONVILLE, AR 72712-1037
(479) 271-9393
(479) 271-0141
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
E4954
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5G686
MEDICARE GROUP PTAN
—
Enumeration date
09/14/2010
Last updated
03/02/2016
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