Provider Demographics
NPI:1720039019
Name:KARIM, SHAKIL A (DO)
Entity Type:Individual
Prefix:
First Name:SHAKIL
Middle Name:A
Last Name:KARIM
Suffix:
Gender:M
Credentials:DO
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 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1822
Practice Address - Country:US
Practice Address - Phone:220-564-4137
Practice Address - Fax:220-564-4119
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009319207RG0100X
WI42-321207RG0100X
OH3400 9 319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109579Medicaid
IL036109579Medicaid
ILK14309Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 16
ILK14310Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 15