Provider Demographics
NPI:1376948901
Name:SHAKEEL, KISHWER
Entity Type:Individual
Prefix:
First Name:KISHWER
Middle Name:
Last Name:SHAKEEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9185
Mailing Address - Country:US
Mailing Address - Phone:224-623-2060
Mailing Address - Fax:
Practice Address - Street 1:969 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-9185
Practice Address - Country:US
Practice Address - Phone:224-623-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician