Provider Demographics
NPI:1477531713
Name:SHAIKH, ATHAR A (MD)
Entity type:Individual
Prefix:DR
First Name:ATHAR
Middle Name:A
Last Name:SHAIKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3709 N CAMPBELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-838-2138
Mailing Address - Fax:520-838-2260
Practice Address - Street 1:480 N MORLEY AVE
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2930
Practice Address - Country:US
Practice Address - Phone:520-287-5728
Practice Address - Fax:520-287-5959
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ29718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ646060Medicaid
AZZ68428Medicare PIN
AZ646060Medicaid