Provider Demographics
NPI:1013995653
Name:SHAIKH, OMER (MD)
Entity Type:Individual
Prefix:DR
First Name:OMER
Middle Name:
Last Name:SHAIKH
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 1:890 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6446
Mailing Address - Country:US
Mailing Address - Phone:330-759-9670
Mailing Address - Fax:330-759-9705
Practice Address - Street 1:4308 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1052
Practice Address - Country:US
Practice Address - Phone:330-759-9670
Practice Address - Fax:330-759-9705
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-4318-S208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2121037Medicaid
OHG99583Medicare UPIN