Provider Demographics
NPI:1073774634
Name:MOHANAD A ELTAHIR DPM PA
Entity Type:Organization
Organization Name:MOHANAD A ELTAHIR DPM PA
Other - Org Name:ALAN F SHADER DPM PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHANAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELTAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-682-2600
Mailing Address - Street 1:3800 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7793
Mailing Address - Country:US
Mailing Address - Phone:305-681-2600
Mailing Address - Fax:305-685-0906
Practice Address - Street 1:3800 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7793
Practice Address - Country:US
Practice Address - Phone:305-681-2600
Practice Address - Fax:305-685-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty