Provider Demographics
NPI:1114969300
Name:SHAIK, MUZAKEER AHMED (MD)
Entity Type:Individual
Prefix:
First Name:MUZAKEER
Middle Name:AHMED
Last Name:SHAIK
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 1:1645 DORCHESTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6443
Mailing Address - Country:US
Mailing Address - Phone:480-235-1079
Mailing Address - Fax:469-888-8174
Practice Address - Street 1:1645 DORCHESTER DR STE A
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6443
Practice Address - Country:US
Practice Address - Phone:480-235-1079
Practice Address - Fax:469-888-8174
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35244207R00000X
TXM8995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115288Medicaid
271802188OtherEMPLOYER TAX ID
TX1972937-03Medicaid
271802188OtherEMPLOYER TAX ID
TX1972937-03Medicaid
AZ116800Medicare PIN
AZ121565Medicare PIN