Healthcare Provider Details

I. General information

NPI: 1184967853
Provider Name (Legal Business Name): OMAIR SHAKIL M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N ELM ST
HENDERSON KY
42420-2783
US

IV. Provider business mailing address

PO BOX 632111
CINCINNATI OH
45263-2111
US

V. Phone/Fax

Practice location:
  • Phone: 270-957-8800
  • Fax: 270-957-8797
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number01101249A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: