Provider Demographics
NPI:1144313370
Name:SHAIKH, KANEEZ BATOOL (MD)
Entity type:Individual
Prefix:
First Name:KANEEZ
Middle Name:BATOOL
Last Name:SHAIKH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 PINE GROVE AVENUE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1530 PINE GROVE AVENUE
Practice Address - Street 2:SUITE 7
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-985-0029
Practice Address - Fax:810-985-0032
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010377622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B48278Medicare UPIN
47607006Medicare ID - Type Unspecified