Provider Demographics
NPI:1083643233
Name:BAKTH, SHAMSHER (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMSHER
Middle Name:
Last Name:BAKTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SE HILLMOOR DR STE C-208
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7574
Mailing Address - Country:US
Mailing Address - Phone:772-337-5083
Mailing Address - Fax:772-337-5088
Practice Address - Street 1:1945 NOOR ST APT 302
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-5125
Practice Address - Country:US
Practice Address - Phone:412-491-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131110207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4046115OtherU.S. HEALTHCARE
PA252908OtherUPMC
PA1050957Medicaid
PAB34967Medicare UPIN
PA4046115OtherU.S. HEALTHCARE