MEDICARE: DR. ELIAS IBRAHIM SHAHEEN 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	207Q00000X	Family Medicine Physician	036128436	IL
2	207Q00000X	Family Medicine Physician	ME123307	FL

General Provider Information

NPI Number	:	1639305972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIAS IBRAHIM SHAHEEN MD

Provider Business Mailing Address
First Line	:	15455 COLLIER BLVD UNIT 201
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-7874
Country	:	US
Telephone Number	:	239-514-2005
Fax Number	:	239-593-0067

Provider Business Practice Location Address
First Line	:	15455 COLLIER BLVD UNIT 201
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-7874
Country	:	US
Telephone Number	:	239-514-2005
Fax Number	:	239-593-0067

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

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	09/20/2024

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