MEDICARE: DR. KHIZER SALIM SHAIKH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	004046	NY
2	207R00000X	Internal Medicine Physician	004046	NY
3	207RP1001X	Pulmonary Disease Physician	269527	NY
4	207RP1001X	Pulmonary Disease Physician	50523	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255560884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHIZER SALIM SHAIKH M.D.

Provider Business Mailing Address
First Line	:	1851 MESQUITE AVE
Second Line	:	SUITE 210
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5677
Country	:	US
Telephone Number	:	928-854-7540
Fax Number	:	928-854-2405

Provider Business Practice Location Address
First Line	:	1851 MESQUITE AVE
Second Line	:	SUITE 210
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5677
Country	:	US
Telephone Number	:	928-854-7540
Fax Number	:	928-854-2405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/16/2015

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