Healthcare Provider Details

I. General information

NPI: 1336123553
Provider Name (Legal Business Name): SHAUKAT HUSSAIN CHOWDHARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11707 CLUB DR
TAMPA FL
33612-5521
US

IV. Provider business mailing address

PO BOX 46518
TAMPA FL
33646-0105
US

V. Phone/Fax

Practice location:
  • Phone: 813-977-2222
  • Fax: 813-977-4222
Mailing address:
  • Phone: 813-977-2222
  • Fax: 813-977-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME67887
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: