Provider Demographics
NPI:1437188372
Name:ABDURRAHIM, SHEHETAJ G (MD)
Entity type:Individual
Prefix:
First Name:SHEHETAJ
Middle Name:G
Last Name:ABDURRAHIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 PRINCE GEORGE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2087
Mailing Address - Country:US
Mailing Address - Phone:972-634-8110
Mailing Address - Fax:972-634-8220
Practice Address - Street 1:2701 PRINCE GEORGE AVE STE 100
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2087
Practice Address - Country:US
Practice Address - Phone:972-634-8110
Practice Address - Fax:972-634-8220
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160498503Medicaid
TX160498502Medicaid
TX160498501Medicaid
TX160498503Medicaid
TX160498501Medicaid
TX8K6989Medicare PIN
TX8A9139Medicare PIN