Healthcare Provider Details

I. General information

NPI: 1235187204
Provider Name (Legal Business Name): HATEM T SHOUKEIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 BROADWAY SUITE 100
BANGOR ME
04401-3929
US

IV. Provider business mailing address

358 BROADWAY SUITE 100
BANGOR ME
04401-3929
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-3550
  • Fax: 207-907-3562
Mailing address:
  • Phone: 207-907-3550
  • Fax: 207-907-3562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD18938
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: