Provider Demographics
NPI:1558434712
Name:DAKOTA EAR NOSE & THROAT CLINIC
Entity Type:Organization
Organization Name:DAKOTA EAR NOSE & THROAT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DAKOTA ENT CLINIC PC
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-353-6575
Mailing Address - Street 1:172 4TH ST SE
Mailing Address - Street 2:STE 401
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350
Mailing Address - Country:US
Mailing Address - Phone:605-353-6575
Mailing Address - Fax:605-353-6576
Practice Address - Street 1:172 4TH ST SE
Practice Address - Street 2:STE 401
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350
Practice Address - Country:US
Practice Address - Phone:605-353-6575
Practice Address - Fax:605-353-6576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5227207Y00000X
WI48503020207Y00000X
ND8429207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9213433OtherDAKOTA CARE
0022505OtherWELLMARK
SD6520350Medicaid
H18097Medicare UPIN
41279Medicare ID - Type Unspecified