Individual
AL M SHANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 781-3444
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 781-3444
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
10140
ND
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
35099267
OH
207RN0300X
Nephrology Physician
35099267
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0065902
—
OH
05
—
7100146510
—
KY
Enumeration date
05/18/2006
Last updated
06/13/2019
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