Provider Demographics
NPI:1770585325
Name:SHAUKAT, MUHAMMAD IMRAN (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:IMRAN
Last Name:SHAUKAT
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 1:1145 S UTICA AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4013
Mailing Address - Country:US
Mailing Address - Phone:918-579-3826
Mailing Address - Fax:918-579-1262
Practice Address - Street 1:8801 S 101ST EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5716
Practice Address - Country:US
Practice Address - Phone:918-232-6915
Practice Address - Fax:918-298-2355
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24180207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100768880JOtherMEDICAID
OK100768880IMedicaid
OK37-1834OtherMEDICARE
OK100768880FOtherMEDICAID
OK200048600AMedicaid
OK37-1803OtherMEDICARE
OK100768880JMedicaid
OK37-1832OtherMEDICARE
OK100768880FMedicaid
OK100768880JMedicaid
OKI25371Medicare UPIN
OK243505604Medicare PIN