Provider Demographics
NPI:1629259742
Name:SHAKIR, MAHA SABAH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHA
Middle Name:SABAH
Last Name:SHAKIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 SOUTHSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-5761
Mailing Address - Country:US
Mailing Address - Phone:503-708-8285
Mailing Address - Fax:
Practice Address - Street 1:17704 JEAN WAY STE 105
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5586
Practice Address - Country:US
Practice Address - Phone:503-387-5546
Practice Address - Fax:503-908-0747
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27868208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR024156OtherMEDICARE