Provider Demographics
NPI:1417275595
Name:SHAWKAT KERO MD PA
Entity Type:Organization
Organization Name:SHAWKAT KERO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWKAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-596-8995
Mailing Address - Street 1:11373 CORTEZ BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5406
Mailing Address - Country:US
Mailing Address - Phone:352-596-8995
Mailing Address - Fax:352-597-0002
Practice Address - Street 1:11373 CORTEZ BLVD STE 401
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5406
Practice Address - Country:US
Practice Address - Phone:352-596-8995
Practice Address - Fax:352-597-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043866207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069665000Medicaid
FLD85402Medicare UPIN
FL26060Medicare PIN