Provider Demographics
NPI:1114184124
Name:SHAKER, MILAD ISHAK (MD)
Entity Type:Individual
Prefix:
First Name:MILAD
Middle Name:ISHAK
Last Name:SHAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 BESSEMER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-9134
Mailing Address - Country:US
Mailing Address - Phone:724-542-4296
Mailing Address - Fax:724-542-4298
Practice Address - Street 1:308 BESSEMER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MOUNT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-9134
Practice Address - Country:US
Practice Address - Phone:724-542-4296
Practice Address - Fax:724-542-4298
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine