Provider Demographics
NPI:1346363967
Name:SHANKAR, MURALI P (MD)
Entity Type:Individual
Prefix:
First Name:MURALI
Middle Name:P
Last Name:SHANKAR
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 1:8200 W. SUNRISE BLVD.
Mailing Address - Street 2:SUITE # D6
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322
Mailing Address - Country:US
Mailing Address - Phone:954-475-1735
Mailing Address - Fax:954-475-1741
Practice Address - Street 1:8200 W. SUNRISE BLVD.
Practice Address - Street 2:SUITE # D6
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322
Practice Address - Country:US
Practice Address - Phone:954-475-1735
Practice Address - Fax:954-475-1741
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060153174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14294OtherBCBS FL
FL5671OtherNHP
FLP00199958OtherRAILROAD MEDICARE
FL174641OtherSTAYWELL
FL14294OtherBCBS FL
FL14294ZMedicare PIN