Provider Demographics
NPI:1538193826
Name:ITANI, SHAKER (MD)
Entity type:Individual
Prefix:DR
First Name:SHAKER
Middle Name:
Last Name:ITANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 S EASTERN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7851
Mailing Address - Country:US
Mailing Address - Phone:702-410-5319
Mailing Address - Fax:702-442-1494
Practice Address - Street 1:4445 S EASTERN AVE STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7851
Practice Address - Country:US
Practice Address - Phone:702-410-5319
Practice Address - Fax:702-442-1494
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19392207RI0200X
IN01079422A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH76906Medicare UPIN
CA00A898670Medicare ID - Type Unspecified