Provider Demographics
NPI:1639169394
Name:ANJUM, SHAKELL (MD)
Entity Type:Individual
Prefix:
First Name:SHAKELL
Middle Name:
Last Name:ANJUM
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 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42474207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
131075OtherU CARE
706S0ANOtherBLUE CROSS BLUE SHIELD
HP40048OtherHEALTH PARTNERS
1040410OtherPREFERRED ONE
P00089413OtherRR MEDICARE
2197290OtherFIRST HEALTH PLAN
801974600OtherMEDICAL ASSISTANCE
CI1369OtherRR MEDICARE
3100203OtherMEDICA HEALTH PLANS
2013639OtherARAZ GROUP AMERICAS PPO
6D05CEOtherBLUE CROSS BLUE SHIELD
3100203OtherMEDICA HEALTH PLANS
706S0ANOtherBLUE CROSS BLUE SHIELD