Provider Demographics
NPI:1083842645
Name:SHAKER, DOROTA MAGDALENE (DO)
Entity Type:Individual
Prefix:DR
First Name:DOROTA
Middle Name:MAGDALENE
Last Name:SHAKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DOROTA
Other - Middle Name:MAGDALENE
Other - Last Name:KOSTRZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1555 NOVICKY CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4051
Mailing Address - Country:US
Mailing Address - Phone:419-944-7407
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology