Provider Demographics
NPI:1306885371
Name:SHANMUGAM, MAKILZHAN (MD)
Entity type:Individual
Prefix:
First Name:MAKILZHAN
Middle Name:
Last Name:SHANMUGAM
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 1:1330 MERCY DR NW STE 101
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2624
Mailing Address - Country:US
Mailing Address - Phone:216-472-2730
Mailing Address - Fax:216-472-2740
Practice Address - Street 1:1330 MERCY DR NW
Practice Address - Street 2:SUITE 101
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2626
Practice Address - Country:US
Practice Address - Phone:330-588-4676
Practice Address - Fax:330-588-4677
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-074146207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
110170325OtherMEDICARE RAILROAD
OH2094102Medicaid
OHG29447Medicare UPIN
OH2094102Medicaid
OHH181311Medicare PIN