ECLAIMS ID / FACILITY

LICENSE/ESTABLISHMENT ID ( DHA-F-
NO PROVIDER NAME AS PER THE LICENSE XXXXXX/MOH-F -XXX/HAAD LICENSE )
1 Shiyas & Ifthikar Medical Center MOH5887
 NAME OF DOCTORS/PHYSIOTHERAPIST
CLINCIANS ECLAIM ID (DHA-P- /PATHOLOGIST/RADIOLOGIST/TECHNICIAN
XXXXX/MOHDXXX/HAAD LICENSE ) (ETC)
MOHD40251 Mohamed Shaahid Ahamed Basheer
 SPECIALITY as per license
Major ( ex.Specialist ( Cardilogist/General Practitioner/ENT
/consultant /GP ) etc) GENDER
Specialist Prosthodontics MALE
NATIONALITY DEGREE
INDIA MDS
 GRADUATED FROM Language/s Spoken
YENEPOYA DENTAL COLLEGE ENGLISH ARABIC HINDI
PART TIME / LICENSE START DATE
FULL TIME FROM ( DD/MM/YYYY) LICENSE END DATE TO (
(ex 01/12/2016) DD/MD/YYYY) (EX 01/12/2016)
FULL TIME 10/19/2021 10/18/2022
JOINING DATE OF THE
DOCTOR IN THE
FACILITY (
DD/MD/YYYY) (EX
01/12/2016)
12/24/2015
NOTE:
Kindly filled up the form for our record purposes. Please note that claims pr
not be accepted.

Please find below requirements for future addition,deletion or changes in

1. Use the ABNIC Doctors Form and provide the complete details if there is a
as license no., validity, specialty etc . Whenever clinician's license is about to
details as soon as possible to update the same in our system and to avoid delay

2. Send the ABNIC Doctors Form along with the license copies of the doctor t
validation .
3. Update all the License of doctors through Eclaim link .
4. Make sure all the license number is in correspond to the medical title of th
5. Make sure all the detail entered will be on capital letters.