Provider Demographics
NPI:1184914723
Name:QAQISH, SHAKER SAMIH (MD)
Entity type:Individual
Prefix:
First Name:SHAKER
Middle Name:SAMIH
Last Name:QAQISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11771 MAUMELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6558
Mailing Address - Country:US
Mailing Address - Phone:501-204-0302
Mailing Address - Fax:501-573-4111
Practice Address - Street 1:11771 MAUMELLE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113
Practice Address - Country:US
Practice Address - Phone:501-204-0302
Practice Address - Fax:501-573-4111
Is Sole Proprietor?:No
Enumeration Date:2011-04-16
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY301234207R00000X, 207RN0300X, 208600000X
MI4301114410207R00000X, 207RN0300X
CAA126465207R00000X, 207RN0300X
ARE-16018207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery