Individual
MITRA SHAMS
Active
Individual
MITRA SHAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
40284
KY
207R00000X
Internal Medicine Physician
TP723
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000699132
ANTHEM - NCMA
KY
01
—
000057058T
HUMANA - NCMA
KY
01
—
121562
SIHO - NCMA
KY
05
—
200859040
—
IN
01
—
50031915
PASSPORT & PP ADVTG - NCMA
KY
05
—
7100020180
—
KY
01
—
7659346
CIGNA - NCMA
KY
01
—
P00893048
RAILROAD MEDICARE - KY
KY
Enumeration date
09/25/2006
Last updated
11/29/2012
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