Shadid, Gregory Ernest
Shadid, Gregory Ernest is an sole proprietor health care provider with primary practice located at 1213 Leeper Ave , South Bend IN 46617-1209. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Shadid, Gregory Ernest can be contacted via phone (574) 302-8786.Contact Information
Primary practice address
1213 Leeper Ave
South Bend IN 46617-1209
Phone: (574) 302-8786
Fax: (405) 310-4417
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 01082994A | Indiana |
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | OK20542 | Oklahoma |
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | K1056 | Texas |
Profile Details
| NPI number | 1811985062 |
|---|---|
| LBN Legal business name | Shadid, Gregory Ernest |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 12th, 2005 |
| Last updated | Jun 3rd, 2024 - about 6 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1811985062 | NPPES |
| Oklahoma | MEDICAID | 100228720B |
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