Provider Demographics
NPI:1275351561
Name:SHAKER MEDICAL CORPORATION
Entity type:Organization
Organization Name:SHAKER MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:GENDY-SHAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-977-1082
Mailing Address - Street 1:1752 E LUGONIA AVE STE 117-1027
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2730
Mailing Address - Country:US
Mailing Address - Phone:951-977-1082
Mailing Address - Fax:
Practice Address - Street 1:1752 E LUGONIA AVE STE 117-1027
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2730
Practice Address - Country:US
Practice Address - Phone:951-977-1082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty