Provider Demographics
NPI:1740208701
Name:MADJAR, SHAHAR (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHAR
Middle Name:
Last Name:MADJAR
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 1:901 LAKESHORE DR.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849
Mailing Address - Country:US
Mailing Address - Phone:906-485-2690
Mailing Address - Fax:906-485-2736
Practice Address - Street 1:901 LAKESHORE DR.
Practice Address - Street 2:SUITE 210
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849
Practice Address - Country:US
Practice Address - Phone:906-485-2690
Practice Address - Fax:906-485-2736
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4301079421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISM079421OtherBCBS LICENSE
MI104856358Medicaid
MI3405202022OtherBCBS PIN
MS5315010427OtherBOARD OF PHARMACY
MS4301079421OtherBOARD OF MEDICINE
MS4301079421OtherBOARD OF MEDICINE
MS4301079421OtherBOARD OF MEDICINE
MI104856358Medicaid