Individual
SHAMIM ISLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4186 PONTIAC LAKE RD, WATERFORD, MI 48328-1258
(248) 674-7337
(248) 674-7335
Mailing address
4186 PONTIAC LAKE RD, WATERFORD, MI 48328-1258
(248) 674-7337
(248) 674-7335
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
SI075290
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4177672
—
MI
Enumeration date
07/14/2005
Last updated
08/14/2013
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