MEDICARE: DR. BEN SIMON SHATIL D.O.

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	207L00000X	Anesthesiology Physician	OS16542	FL
2	207L00000X	Anesthesiology Physician	101995-875	WI
3	207L00000X	Anesthesiology Physician	295817	NY
4	207L00000X	Anesthesiology Physician	83639	GA

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	:	1619396397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEN SIMON SHATIL D.O.

Provider Business Mailing Address
First Line	:	3316 GRIFFIN RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5554
Country	:	US
Telephone Number	:	954-832-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3314 GRIFFIN RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5554
Country	:	US
Telephone Number	:	755-215-3790
Fax Number	:

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

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	04/10/2026

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Directions to “ DR. BEN SIMON SHATIL D.O.” Practice Location

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