Provider Demographics
NPI:1760524573
Name:KAHN, SHAKEEL AZIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAKEEL
Middle Name:AZIZ
Last Name:KAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5225 S HIGHWAY 95
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-9111
Mailing Address - Country:US
Mailing Address - Phone:928-768-1011
Mailing Address - Fax:928-768-1075
Practice Address - Street 1:5225 S HIGHWAY 95
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9111
Practice Address - Country:US
Practice Address - Phone:928-768-1011
Practice Address - Fax:928-768-1075
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7633A208VP0000X
AZ37896207Q00000X, 207QB0002X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ121689Medicare PIN