Provider Demographics
NPI:1407546518
Name:DR. SHAKER LTD.
Entity Type:Organization
Organization Name:DR. SHAKER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKER
Authorized Official - Middle Name:
Authorized Official - Last Name:QAQISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-985-5081
Mailing Address - Street 1:11771 MAUMELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6558
Mailing Address - Country:US
Mailing Address - Phone:501-204-0302
Mailing Address - Fax:501-573-4111
Practice Address - Street 1:11771 MAUMELLE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-6558
Practice Address - Country:US
Practice Address - Phone:501-204-0302
Practice Address - Fax:501-573-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty