Provider Demographics
NPI:1598859316
Name:MACKER, SHAILY PARAMJEET (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAILY
Middle Name:PARAMJEET
Last Name:MACKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAILY
Other - Middle Name:P
Other - Last Name:MACKER VIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1719 N DYSART RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-1213
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:105 SARAVANOS RD
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-5813
Practice Address - Country:US
Practice Address - Phone:630-553-4600
Practice Address - Fax:815-705-1701
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ61762207Q00000X
IL036135004207Q00000X
CAA91265207Q00000X
WI48216-020207Q00000X
IN01072590A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400371480OtherMEDICARE
IN151020013OtherMEDICARE PTAN
IN201162210Medicaid
INP01225600OtherRAILROAD MEDICARE
INP01225600OtherRAILROAD MEDICARE