Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 2901019721 | MI |
Y | 1223G0001X | General Practice | 12011765A | IN |
Y | 213EG0000X | General Practice | 12011765A | IN |
NPI | 1710166848 |
---|---|
Provider Name | Dr. Maie M Shabana |
First Address | Pueblo, CO 81003 |
Second Address | Gary, IN 46408-1428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2007 |
Last Update Date | 07/02/2012 |