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General NPI Number Information
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NPI Number | 1558434712
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Entity Type | Organization
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Legal Business Name | DAKOTA EAR NOSE & THROAT CLINIC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 172 4TH ST SE STE 401
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City | HURON
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State | SD
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Zip | 57350
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Country | US
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Telephone | 605-353-6575
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Fax | 605-353-6576
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Provider Business Mailing Address
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Address Line | 172 4TH ST SE STE 401
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City | HURON
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State | SD
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Zip | 57350
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Country | US
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Telephone | 605-353-6575
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Fax | 605-353-6576
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Authorized Official
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Title or Position | PRESIDENT DAKOTA ENT CLINIC PC
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Name | DR. MOHAMMAD R SHAKER
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Credential | MD
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Telephone | 605-353-6575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 48503020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 8429
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 5227
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License Number State | SD
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