1801902242 NPI number — IRA M SHULMAN MD PA

Table of content: (NPI 1801902242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801902242 NPI number — IRA M SHULMAN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRA M SHULMAN MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801902242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 NW 70 AVE
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-792-5750
Provider Business Mailing Address Fax Number:
954-581-0567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 NW 70 AVE
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-792-5750
Provider Business Practice Location Address Fax Number:
954-581-0567
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHULMAN
Authorized Official First Name:
IRA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PHYSICIAN PRESIDENT
Authorized Official Telephone Number:
954-792-5750

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  22186 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2000960 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 372126400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203800 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 78067 . This is a "BLUECROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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