Individual
SHACHAR LAKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 MOYE BLVD, GREENVILLE, NC 27834-4300
(252) 744-4110
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036116803
IL
208600000X
Surgery Physician
2009019133
MO
208600000X
Surgery Physician
Primary
2016-00193
NC
2086X0206X
Surgical Oncology Physician
2016-00193
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558563205
—
MO
05
—
1558563205
—
NC
01
—
19QDC
BCBS OF NC
NC
01
—
3032600
UNITED HEALTHCARE
MO
01
—
96626
HEALTHCARE USA
MO
01
—
NCY4050322
MEDICARE
NC
Enumeration date
06/04/2007
Last updated
07/21/2022
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