MEDICARE: DR. MAHA SABAH SHAKIR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD27868	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	024156	OTHER	OR	MEDICARE

General Provider Information

NPI Number	:	1629259742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHA SABAH SHAKIR M.D.

Provider Business Mailing Address
First Line	:	2557 SOUTHSHORE BLVD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-5761
Country	:	US
Telephone Number	:	503-708-8285
Fax Number	:

Provider Business Practice Location Address
First Line	:	17704 JEAN WAY STE 105
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-5586
Country	:	US
Telephone Number	:	503-387-5546
Fax Number	:	503-908-0747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	07/21/2022

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