Healthcare Provider Details

I. General information

NPI: 1245679430
Provider Name (Legal Business Name): MARGARET SUHAIL SHATARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 CHICAGO AVE # CSC175
MINNEAPOLIS MN
55404-4289
US

IV. Provider business mailing address

2530 CHICAGO AVE # CSC175
MINNEAPOLIS MN
55404-4289
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-5940
  • Fax: 612-813-7258
Mailing address:
  • Phone: 612-813-5940
  • Fax: 612-813-7258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number77214
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: