Provider Demographics
NPI:1417935560
Name:SHEKITKA, KRIS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:MICHAEL
Last Name:SHEKITKA
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 1:3312 GOLD MINE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-2715
Mailing Address - Country:US
Mailing Address - Phone:301-774-3424
Mailing Address - Fax:
Practice Address - Street 1:900 CATON AVE
Practice Address - Street 2:ST AGNES HOSPITAL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:410-368-2746
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037359207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK668C509Medicare ID - Type UnspecifiedPROVIDER NUMBER
MDH80113Medicare UPIN