Provider Demographics
NPI:1477780153
Name:SHORELINE UROCARE PL
Entity Type:Organization
Organization Name:SHORELINE UROCARE PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMOUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-650-1064
Mailing Address - Street 1:11373 CORTEZ BLVD STE 405
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:352-650-1064
Mailing Address - Fax:
Practice Address - Street 1:11373 CORTEZ BLVD STE 405
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:352-650-1064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 104726208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 104726OtherMEDICAL LICENSE