Provider Demographics
NPI:1174544068
Name:WIKAS, SCHIELD M (DO)
Entity type:Individual
Prefix:
First Name:SCHIELD
Middle Name:M
Last Name:WIKAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29111 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:330-492-0953
Practice Address - Street 1:4240 MUNSON ST NW STE C
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2978
Practice Address - Country:US
Practice Address - Phone:330-492-2327
Practice Address - Fax:330-492-0953
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003116W207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0565919Medicaid
OH0546772Medicare PIN
OH0565919Medicaid