Provider Demographics
NPI:1467640151
Name:MUBARIK AHMAD SHAH MD PA
Entity Type:Organization
Organization Name:MUBARIK AHMAD SHAH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUBARIK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-721-3939
Mailing Address - Street 1:3918 VIA POINCIANA
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2991
Mailing Address - Country:US
Mailing Address - Phone:561-721-3939
Mailing Address - Fax:561-439-6851
Practice Address - Street 1:3918 VIA POINCIANA
Practice Address - Street 2:SUITE 10
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2991
Practice Address - Country:US
Practice Address - Phone:561-721-3939
Practice Address - Fax:561-439-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89362208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6543Medicare PIN