MEDICARE: MICHAEL L SHAWBITZ 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	ME38803	FL

General Provider Information

NPI Number	:	1780695478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL L SHAWBITZ M.D.

Provider Business Mailing Address
First Line	:	1034 MAR WALT DR
Second Line	:	SUITE 100
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6639
Country	:	US
Telephone Number	:	850-315-9211
Fax Number	:	850-315-9350

Provider Business Practice Location Address
First Line	:	1034 MAR WALT DR
Second Line	:	SUITE 100
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6639
Country	:	US
Telephone Number	:	850-315-9211
Fax Number	:	850-315-9350

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	12/12/2013

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