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General NPI Number Information
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NPI Number | 1639223928
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Entity Type | Individual
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Provider Name | MOHAMMAD R SHAKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 1150 ESSINGTON RD STE 101
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City | JOLIET
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State | IL
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Zip | 60435-8447
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Country | US
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Telephone | 888-938-3838
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Fax | 888-919-1083
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone | 888-720-2012
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number | 48503
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License Number State | WI
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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 | 036-105323
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License Number State | IL
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