Healthcare Provider Details

I. General information

NPI: 1790105443
Provider Name (Legal Business Name): SHOAIB SHAKEEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 TAYLOR STATION RD STE 200
COLUMBUS OH
43213-4470
US

IV. Provider business mailing address

150 TAYLOR STATION RD STE 200
COLUMBUS OH
43213-4470
US

V. Phone/Fax

Practice location:
  • Phone: 614-627-1300
  • Fax: 614-627-1304
Mailing address:
  • Phone: 614-627-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number5051010019
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number5051010019
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: