Provider Demographics
NPI:1942466156
Name:UMAR, SHAHEEN IBRAHIM (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHEEN
Middle Name:IBRAHIM
Last Name:UMAR
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:12606 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3421
Practice Address - Country:US
Practice Address - Phone:509-924-6650
Practice Address - Fax:094-735-4905
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090360512085N0700X, 2085R0202X
IL125.0544602085N0700X
IL036.1246452085R0202X
WAMD610563722085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0429128OtherL&I-SOUTH SOUND RADIOLOGY
WA2166230OtherL&I-VANCOUVER RADIOLOGY
WA0429123OtherL&I-RADIA KING CTY
WA0429127OtherL&I-EVERGREEN RADIA
WA2166230Medicaid
WA2166230OtherL&I-SEATTLE RADIOLOGY
WA0429122OtherL&I-RADIA REST OF WA
WA0429124OtherL&I-SWEDISH RADIA EDMONDS