Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 036087200 | IL |
N | 207RH0002X | Hospice and Palliative Medicine | 036087200 | IL |
NPI | 1093780926 |
---|---|
Provider Name | Dr. Shakib S Sakla |
First Address | Burr Ridge, IL 60527-5975 |
Second Address | Burr Ridge, IL 60527-5975 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 22/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0002233063 | BCBS (01) | IL |
036087200 | (05) | IL |
E14916 | (02) | IL |