MEDICARE: SHAZIA MUKADDAM 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
1	207R00000X	Internal Medicine Physician	25MA08136600	NJ
2	207R00000X	Internal Medicine Physician	ME129980	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356429625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAZIA MUKADDAM MD

Provider Business Mailing Address
First Line	:	1395 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-5710
Country	:	US
Telephone Number	:	954-281-7700
Fax Number	:	954-715-7603

Provider Business Practice Location Address
First Line	:	5100 COCONUT CREEK PKWY
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-3913
Country	:	US
Telephone Number	:	954-281-7700
Fax Number	:	954-715-7603

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	03/10/2022

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Directions to “ SHAZIA MUKADDAM MD” Practice Location

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