Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 036108958 | IL |
NPI | 1033187505 |
---|---|
Provider Name | Sahar Aboul Rahim Fathallah-Shaykh |
First Address | Birmingham, AL 35294-0001 |
Second Address | Birmingham, AL 35233-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 24/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104180 CHS | (05) | AL |
107633 HSF | (05) | AL |
515-93067 | BCBS HSF (01) | AL |
515-93068 | BCBS CHS (01) | AL |
I49795 | (02) |