MEDICARE: MARK SHACHNER 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	208600000X	Surgery Physician	ME0062046	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00811387	OTHER	FL	MEDICARE RAILROAD

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
3	204679	OTHER	FL	AVMED
4	0163178	OTHER	FL	GHI
5	14969	OTHER	FL	BLUECROSSBLUESHIELD
6	002683	OTHER	FL	NHP
7	0100553	OTHER	FL	GHI
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568464410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK SHACHNER MD

Provider Business Mailing Address
First Line	:	3001 CORAL HILLS DR
Second Line	:	SUITE 320
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4172
Country	:	US
Telephone Number	:	954-755-0111
Fax Number	:	954-755-2209

Provider Business Practice Location Address
First Line	:	3001 CORAL HILLS DR
Second Line	:	SUITE 320
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4172
Country	:	US
Telephone Number	:	954-755-0111
Fax Number	:	954-755-2209

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	11/10/2010

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Directions to “ MARK SHACHNER MD” Practice Location

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