Provider Demographics
NPI:1255560884
Name:SHAIKH, KHIZER SALIM (MD)
Entity type:Individual
Prefix:DR
First Name:KHIZER
Middle Name:SALIM
Last Name:SHAIKH
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 1:1851 MESQUITE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5677
Mailing Address - Country:US
Mailing Address - Phone:928-854-7540
Mailing Address - Fax:928-854-2405
Practice Address - Street 1:1851 MESQUITE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5677
Practice Address - Country:US
Practice Address - Phone:928-854-7540
Practice Address - Fax:928-854-2405
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004046208M00000X, 207R00000X
NY269527207RP1001X
AZ50523207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03463449Medicaid
NYL0712AMedicare PIN
NYJ400074445Medicare PIN
NYJ400074446Medicare PIN
NY03463449Medicaid