Healthcare Provider Details

I. General information

NPI: 1144763772
Provider Name (Legal Business Name): MEDFLORIDA HOSPITALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3889 MILITARY TRL STE 104
JUPITER FL
33458-2923
US

IV. Provider business mailing address

PO BOX 4189
DEERFIELD BEACH FL
33442-4189
US

V. Phone/Fax

Practice location:
  • Phone: 561-406-6080
  • Fax: 561-406-6073
Mailing address:
  • Phone: 954-363-9582
  • Fax: 964-363-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME94252
License Number StateFL

VIII. Authorized Official

Name: MAZIN SHIKARA
Title or Position: CEO
Credential: M.D.
Phone: 561-779-1652