Provider Demographics
NPI:1477513968
Name:TARAKJI, MUHIB SHUKRI (MD)
Entity Type:Individual
Prefix:
First Name:MUHIB
Middle Name:SHUKRI
Last Name:TARAKJI
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:PO BOX 8432
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-0432
Mailing Address - Country:US
Mailing Address - Phone:304-766-2101
Mailing Address - Fax:304-766-2225
Practice Address - Street 1:418 GREENWAY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1426
Practice Address - Country:US
Practice Address - Phone:304-766-2101
Practice Address - Fax:304-766-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11488207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096577000Medicaid
001720410OtherBLUE CROSS BLUE SHIELD
001720410OtherBLUE CROSS BLUE SHIELD
WV0096577000Medicaid
WV6188170001Medicare NSC