Provider Demographics
NPI:1164492542
Name:HANUBAL, SHIVAKUMAR S (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVAKUMAR
Middle Name:S
Last Name:HANUBAL
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 1:1414 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5329
Mailing Address - Country:US
Mailing Address - Phone:352-728-3898
Mailing Address - Fax:352-728-6240
Practice Address - Street 1:1414 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5329
Practice Address - Country:US
Practice Address - Phone:352-728-3898
Practice Address - Fax:352-728-6240
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0062736207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371347400Medicaid
FL001553588Medicaid
FL18070Medicare ID - Type Unspecified
FL18070TMedicare PIN
FL001553588Medicaid