Healthcare Provider Details

I. General information

NPI: 1760586044
Provider Name (Legal Business Name): MICHAEL ROY SHOOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 NW 51 ST
BOCA RATON FL
33431
US

IV. Provider business mailing address

8016 MIZNER LN
BOCA RATON FL
33433-1134
US

V. Phone/Fax

Practice location:
  • Phone: 561-997-8111
  • Fax: 561-995-0109
Mailing address:
  • Phone: 800-427-1902
  • Fax: 561-883-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME50883
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: