Provider Demographics
NPI:1225143886
Name:SHAKER, WAHIB (MD)
Entity Type:Individual
Prefix:
First Name:WAHIB
Middle Name:
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 1:44428 WOODWARD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-858-6272
Mailing Address - Fax:248-858-6279
Practice Address - Street 1:44428 WOODWARD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5009
Practice Address - Country:US
Practice Address - Phone:248-858-6272
Practice Address - Fax:248-858-6279
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWS034475207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1390439Medicaid
MI1606304562OtherBCBS
MI0630456Medicare ID - Type UnspecifiedMEDICARE
MI1606304562OtherBCBS