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General NPI Number Information
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NPI Number | 1467640151
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Entity Type | Organization
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Legal Business Name | MUBARIK AHMAD SHAH MD PA
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 3918 VIA POINCIANA SUITE 10
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City | LAKE WORTH
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State | FL
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Zip | 33467-2991
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Country | US
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Telephone | 561-721-3939
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Fax | 561-439-6851
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Provider Business Mailing Address
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Address Line | 3918 VIA POINCIANA SUITE 10
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City | LAKE WORTH
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State | FL
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Zip | 33467-2991
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Country | US
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Telephone | 561-721-3939
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Fax | 561-439-6851
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Authorized Official
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Title or Position | PRESIDENT
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Name | MUBARIK A SHAH
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Credential | M.D.
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Telephone | 561-721-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME89362
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME89362
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License Number State | FL
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