Provider Demographics
NPI:1821443276
Name:SHANKAR, VIKRAM (MD)
Entity type:Individual
Prefix:
First Name:VIKRAM
Middle Name:
Last Name:SHANKAR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14614 N KIERLAND BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2743
Mailing Address - Country:US
Mailing Address - Phone:833-836-8326
Mailing Address - Fax:
Practice Address - Street 1:4200 NW NORTH RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-2593
Practice Address - Country:US
Practice Address - Phone:503-799-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA155066207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine