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General NPI Number Information
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NPI Number | 1902833288
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Entity Type | Organization
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Legal Business Name | SHAHLA MEDICAL GROUP, PA
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 8800 TERRENE CT STE 102
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-9900
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Country | US
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Telephone | 239-948-3444
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Fax | 239-948-9028
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Provider Business Mailing Address
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Address Line | 8800 TERRENE CT STE 102
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-9900
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Country | US
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Telephone | 239-948-3444
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Fax | 239-948-9028
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Authorized Official
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Title or Position | PRESIDENT
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Name | ZIAD SHAHLA
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Credential | MD
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Telephone | 239-948-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0066854
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License Number State | FL
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