Provider Demographics
NPI:1881868958
Name:JACOB, SHAHEEN KAKA (MD)
Entity type:Individual
Prefix:
First Name:SHAHEEN
Middle Name:KAKA
Last Name:JACOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 N JOSEY LN
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4633
Mailing Address - Country:US
Mailing Address - Phone:972-939-7011
Mailing Address - Fax:972-939-2951
Practice Address - Street 1:4323 N JOSEY LN
Practice Address - Street 2:SUITE 306
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4633
Practice Address - Country:US
Practice Address - Phone:972-939-7011
Practice Address - Fax:972-939-2951
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3736207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309929YUDOtherMEDICARE PTAN
TXP3736OtherMEDICAL LICENSE
TX327547101Medicaid