Provider Demographics
NPI:1639223928
Name:SHAKER, MOHAMMAD R (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:R
Last Name:SHAKER
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:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:888-720-2012
Mailing Address - Fax:
Practice Address - Street 1:1150 ESSINGTON RD STE 101
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8447
Practice Address - Country:US
Practice Address - Phone:888-938-3838
Practice Address - Fax:888-919-1083
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48503020207Y00000X
WI48503207YX0901X
IL036-105323207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105323Medicaid
WI34689900Medicaid
SD6520350Medicaid
0022505OtherWELLMARK
9213433OtherDAKOTA CARE
9213433OtherDAKOTA CARE
SD6520350Medicaid