Provider Demographics
NPI:1891881231
Name:SHIHADEH, ESSAM D (MD)
Entity Type:Individual
Prefix:
First Name:ESSAM
Middle Name:D
Last Name:SHIHADEH
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:P.O. BOX 24571
Mailing Address - Street 2:MAILSTOP 3100117
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0571
Mailing Address - Country:US
Mailing Address - Phone:907-452-5380
Mailing Address - Fax:907-458-6984
Practice Address - Street 1:1650 COWLES STREET
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-458-5380
Practice Address - Fax:907-743-2641
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK44982085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD4498Medicaid
H35514Medicare UPIN
AKMD4498Medicaid