Provider Demographics
NPI:1578515862
Name:SHAKIR, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:SHAKIR
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 1:1100 S DOBSON RD
Mailing Address - Street 2:102
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6157
Mailing Address - Country:US
Mailing Address - Phone:480-855-4078
Mailing Address - Fax:480-855-4081
Practice Address - Street 1:1100 S DOBSON RD
Practice Address - Street 2:102
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6157
Practice Address - Country:US
Practice Address - Phone:480-855-4078
Practice Address - Fax:480-855-4081
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29303174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ584210Medicaid
AZ584210Medicaid
AZZ107102Medicare PIN
AZZ107103Medicare PIN