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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