MEDICARE: DR. SHAHAB U KIDWAI 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	174400000X	Specialist	ME0036081	FL
2	2084N0400X	Neurology Physician	ME0036081	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

General Provider Information

NPI Number	:	1780671263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHAB U KIDWAI M.D.

Provider Business Mailing Address
First Line	:	2000 N FEDERAL HWY
Second Line	:	SUITE 203
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1022
Country	:	US
Telephone Number	:	954-783-0223
Fax Number	:	954-786-8628

Provider Business Practice Location Address
First Line	:	2000 N FEDERAL HWY
Second Line	:	SUITE 203
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1022
Country	:	US
Telephone Number	:	954-783-0223
Fax Number	:	954-786-8628

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	04/17/2018

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