Provider Demographics
NPI:1790933612
Name:DR. AMATHUL AZEEM SHAKIR
Entity Type:Organization
Organization Name:DR. AMATHUL AZEEM SHAKIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMATHUL
Authorized Official - Middle Name:AZEEM
Authorized Official - Last Name:SHAKIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-495-3586
Mailing Address - Street 1:1435 N ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-3348
Mailing Address - Country:US
Mailing Address - Phone:405-495-3586
Mailing Address - Fax:405-495-3586
Practice Address - Street 1:1435 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-3348
Practice Address - Country:US
Practice Address - Phone:405-495-3586
Practice Address - Fax:405-495-3597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12648207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100013230AMedicaid
OK1306947767OtherINDIVIDUAL NPI
OK100013230AMedicaid
OK105600015Medicare PIN