Provider Demographics
NPI:1083930275
Name:SVOBODA, SHANE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:MICHAEL
Last Name:SVOBODA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6130 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3557
Mailing Address - Country:US
Mailing Address - Phone:520-219-8690
Mailing Address - Fax:520-219-8694
Practice Address - Street 1:6130 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3557
Practice Address - Country:US
Practice Address - Phone:520-219-8690
Practice Address - Fax:520-219-8694
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0077538208600000X
ORMD202987208600000X
AZ67333208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery