Provider Demographics
NPI:1467567941
Name:SHIMSHAK, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SHIMSHAK
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 1:4240 SUN N LAKE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1944
Mailing Address - Country:US
Mailing Address - Phone:863-471-3926
Mailing Address - Fax:863-385-3093
Practice Address - Street 1:4240 SUN N LAKE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-1944
Practice Address - Country:US
Practice Address - Phone:863-471-3926
Practice Address - Fax:863-385-3093
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122398207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30554100Medicaid
WI30554100Medicaid