=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841235165
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLES P SHENKER MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2006
-----------------------------------------------------
Last Update Date | 03/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21150 BISCAYNE BLVD STE 208
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-705-0501
-----------------------------------------------------
Fax | 305-705-0502
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21150 BISCAYNE BLVD STE 208
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-705-0501
-----------------------------------------------------
Fax | 305-705-0502
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHARLES PAUL SHENKER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-705-0501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------