Provider Demographics
NPI:1144763772
Name:MEDFLORIDA HOSPITALISTS LLC
Entity Type:Organization
Organization Name:MEDFLORIDA HOSPITALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIKARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-779-1652
Mailing Address - Street 1:3889 MILITARY TRL STE 104
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2923
Mailing Address - Country:US
Mailing Address - Phone:561-406-6080
Mailing Address - Fax:561-406-6073
Practice Address - Street 1:3889 MILITARY TRL STE 104
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2923
Practice Address - Country:US
Practice Address - Phone:561-406-6080
Practice Address - Fax:561-406-6073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 208M00000X
FLME94252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019598200Medicaid
FL019598200Medicaid