Basic Information
| Provider Information | |||||||||
| NPI: | 1386656049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAKOOB | ||||||||
| FirstName: | SHAHID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13634 N 93RD AVE | ||||||||
| Address2: | #100 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239330301 | ||||||||
| FaxNumber: | 6239330224 | ||||||||
| Practice Location | |||||||||
| Address1: | 13634 N 93RD AVE | ||||||||
| Address2: | #100 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239330301 | ||||||||
| FaxNumber: | 6239330224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 01/14/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD425240 | PA | N | Other Service Providers | Specialist | 207RP1001X | 40370 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 418685 | 05 | AZ | MEDICAID |