MEDICARE: MICHAEL L SHAWBITZ M D P A

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
1	2084N0400X	Neurology Physician	ME0038803	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1144462110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL L SHAWBITZ M D P A

Provider Business Mailing Address
First Line	:	1034 MAR WALT DR
Second Line	:	SUITE 100
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6639
Country	:	US
Telephone Number	:	850-863-2153
Fax Number	:	850-315-9350

Provider Business Practice Location Address
First Line	:	1034 MAR WALT DR
Second Line	:	SUITE 100
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6639
Country	:	US
Telephone Number	:	850-863-2153
Fax Number	:	850-315-9350

Authorized Official
Title or Position	:	BUSINESS OFFICE ANALYST
Name	:	MS. DAWN L LOPER
Credential	:
Telephone Number	:	850-315-9211

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	07/17/2013

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