Provider Demographics
NPI:1588663298
Name:MOHAMMED, SHAKIL (MD)
Entity Type:Individual
Prefix:
First Name:SHAKIL
Middle Name:
Last Name:MOHAMMED
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 1:540 CODY PASS
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2521
Mailing Address - Country:US
Mailing Address - Phone:513-521-6341
Mailing Address - Fax:
Practice Address - Street 1:415 STRAIGHT ST
Practice Address - Street 2:STE 403
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1060
Practice Address - Country:US
Practice Address - Phone:513-559-2580
Practice Address - Fax:513-559-2596
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350329422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0255067Medicaid
OHMO0134695Medicare ID - Type Unspecified
OH0255067Medicaid