Basic Information
| Provider Information | |||||||||
| NPI: | 1639117120 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAUKAT | ||||||||
| FirstName: | KHAYAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 291 INDEPENDENCE DR | ||||||||
| Address2: | INTERNAL MEDICINE | ||||||||
| City: | CHESTNUT HILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024673628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175416505 | ||||||||
| FaxNumber: | 6715416444 | ||||||||
| Practice Location | |||||||||
| Address1: | 291 INDEPENDENCE DR | ||||||||
| Address2: | INTERNAL MEDICINE | ||||||||
| City: | CHESTNUT HILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024673628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175416505 | ||||||||
| FaxNumber: | 6175416444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 08/16/2017 | ||||||||
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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 | 207R00000X | ME101820 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 350582718S | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | ME101820 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 226708 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2158205 | 05 | MA | MEDICAID | 2438393 | 05 | OH | MEDICAID |