Provider Demographics
NPI:1871567396
Name:SHAKHASHIRO, GHASSAN (MD)
Entity type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:
Last Name:SHAKHASHIRO
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 1:1 SAINT JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3742
Mailing Address - Country:US
Mailing Address - Phone:859-313-2963
Mailing Address - Fax:859-313-3541
Practice Address - Street 1:1 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3742
Practice Address - Country:US
Practice Address - Phone:859-313-2963
Practice Address - Fax:859-313-3541
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35630207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64020969Medicaid
KY6649Medicare PIN
KY8001Medicare PIN
KY110222012Medicare PIN
KYH10740Medicare UPIN
KY0664901Medicare PIN
KY8577Medicare PIN
KY64020969Medicaid
KY183440Medicare PIN
KY5491Medicare PIN