Provider Demographics
NPI:1245679430
Name:SHATARA, MARGARET SUHAIL (MD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:SUHAIL
Last Name:SHATARA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2530 CHICAGO AVE # CSC175
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4289
Mailing Address - Country:US
Mailing Address - Phone:612-813-5940
Mailing Address - Fax:612-813-7258
Practice Address - Street 1:2530 CHICAGO AVE # CSC175
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4289
Practice Address - Country:US
Practice Address - Phone:612-813-5940
Practice Address - Fax:612-813-7258
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN772142080P0207X
MO20200272562080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200087946Medicaid