Healthcare Provider Details

I. General information

NPI: 1932271988
Provider Name (Legal Business Name): EBRAHIM MOHAMMED SHAKIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16945 FRANCES ST
OMAHA NE
68130-2312
US

IV. Provider business mailing address

16945 FRANCES ST
OMAHA NE
68130-2312
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-7400
  • Fax: 402-397-0115
Mailing address:
  • Phone: 402-397-7400
  • Fax: 402-397-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50266
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number50266
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26247
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number26247
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: