Healthcare Provider Details

I. General information

NPI: 1790165876
Provider Name (Legal Business Name): SHAAN AKHTAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 NW 4TH ST STE A
REDMOND OR
97756-1328
US

IV. Provider business mailing address

6431 FANNIN ST STE MSB 4156
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-7761
  • Fax: 541-598-3485
Mailing address:
  • Phone: 602-400-8061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number94-08660
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: