Provider Demographics
NPI:1780814863
Name:SHAUKAT, ISMAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:
Last Name:SHAUKAT
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 1:4305 W MEDICAL CENTER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8425
Mailing Address - Country:US
Mailing Address - Phone:815-759-8100
Mailing Address - Fax:815-759-8106
Practice Address - Street 1:4305 W MEDICAL CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8425
Practice Address - Country:US
Practice Address - Phone:815-759-8100
Practice Address - Fax:815-759-8106
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO8560600207R00000X
IL036128951207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine