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NPI Code Detail

MEDICARE: ALEKSEY PETROVICH SHUBIN MD

MEDICARE: ALEKSEY PETROVICH SHUBIN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianME158126FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003445602
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEKSEY PETROVICH SHUBIN MD
Provider Business Mailing Address
First Line : 4780 SW 64TH AVE STE 103
Second Line :
City : DAVIE
State : FL
Zip : 33314-4400
Country : US
Telephone Number : 954-434-1705
Fax Number :
Provider Business Practice Location Address
First Line : 1437 S FEDERAL HWY
Second Line :
City : DANIA BEACH
State : FL
Zip : 33004-4348
Country : US
Telephone Number : 954-399-9941
Fax Number : 954-399-9987
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2020
Last Update Date : 03/03/2026

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