=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376552075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHIV KUMAR AGGARWAL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 04/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5522 TROUBLE CREEK RD STE 100
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-5171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-842-7088
-----------------------------------------------------
Fax | 727-848-6731
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5522 TROUBLE CREEK RD STE 100
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-5171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-842-7088
-----------------------------------------------------
Fax | 727-848-6731
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0061805
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------