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1982638466

NPI Code Detail

MEDICARE: DR. MARTIN ENGWALL SHELINE MD

MEDICARE: DR. MARTIN ENGWALL SHELINE 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	2085R0204X	Vascular & Interventional Radiology Physician	34710	GA
2	2085R0202X	Diagnostic Radiology Physician	ME109093	FL
3	2085R0204X	Vascular & Interventional Radiology Physician	ME109093	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
2	14E53	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982638466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN ENGWALL SHELINE MD

Provider Business Mailing Address
First Line	:	P.O. BOX 1770
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32402-1770
Country	:	US
Telephone Number	:	850-747-4905
Fax Number	:	850-747-4907

Provider Business Practice Location Address
First Line	:	527 N. PALO ALTO AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3639
Country	:	US
Telephone Number	:	850-747-4905
Fax Number	:	850-747-4907

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	10/06/2011

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Directions to “ DR. MARTIN ENGWALL SHELINE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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