Provider Demographics
NPI:1699833970
Name:SANDOZI, SHAKEEL SHER KHAN (MD)
Entity Type:Individual
Prefix:
First Name:SHAKEEL
Middle Name:SHER KHAN
Last Name:SANDOZI
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 1:625 S FIFTH STREET
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970
Mailing Address - Country:US
Mailing Address - Phone:815-432-3805
Mailing Address - Fax:815-432-3955
Practice Address - Street 1:625 S FIFTH STREET
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970
Practice Address - Country:US
Practice Address - Phone:815-432-3805
Practice Address - Fax:815-432-3955
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087004208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200509430AMedicaid
IL0360870041OtherILLINOIUS PUBLIC AID
IL0360870041OtherILLINOIUS PUBLIC AID
IN200509430AMedicaid