MEDICARE: DR. KEVIN B SHROCK M.D.

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	207X00000X	Orthopaedic Surgery Physician	01098946A	IN
2	207X00000X	Orthopaedic Surgery Physician	ME0066180	FL

General Provider Information

NPI Number	:	1154327260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN B SHROCK M.D.

Provider Business Mailing Address
First Line	:	551 N FEDERAL HWY STE 800
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2559
Country	:	US
Telephone Number	:	954-715-7472
Fax Number	:	954-764-5522

Provider Business Practice Location Address
First Line	:	551 N FEDERAL HWY STE 800
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2559
Country	:	US
Telephone Number	:	954-715-7472
Fax Number	:	954-764-5522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	03/02/2026

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