MEDICARE: SHAHID RASUL RANDHAWA 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	207KA0200X	Allergy Physician	ME92264	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16010	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376532580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHID RASUL RANDHAWA M.D.

Provider Business Mailing Address
First Line	:	5333 N DIXIE HWY
Second Line	:	STE 109
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-3453
Country	:	US
Telephone Number	:	954-717-1919
Fax Number	:	954-717-2528

Provider Business Practice Location Address
First Line	:	2510 E OAKLAND PARK BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1601
Country	:	US
Telephone Number	:	954-717-1919
Fax Number	:	954-717-2528

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	11/05/2021

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