Provider Demographics
NPI:1487869806
Name:ISLAM, ANDREW SHAFIK (MD, MS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SHAFIK
Last Name:ISLAM
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-354-7650
Mailing Address - Fax:513-246-2391
Practice Address - Street 1:8311 MONTGOMERY ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45263-4418
Practice Address - Country:US
Practice Address - Phone:513-354-3700
Practice Address - Fax:513-745-0409
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35093372207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200986890Medicaid
OH3045770Medicaid
OH3045770Medicaid
INM400020531Medicare PIN