Provider Demographics
NPI:1477784247
Name:SHIBANI, AKRAM M (MD)
Entity Type:Individual
Prefix:
First Name:AKRAM
Middle Name:M
Last Name:SHIBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6017
Mailing Address - Fax:904-450-6041
Practice Address - Street 1:4203 BELFORT RD STE 4015
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1409
Practice Address - Country:US
Practice Address - Phone:904-450-6460
Practice Address - Fax:904-450-6469
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA72809207RC0200X, 207RP1001X
WI60719-020207RP1001X
FLME147082207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP01359651Medicare PIN
WI741501984Medicare PIN
WI543401723Medicare PIN
WI130800412Medicare PIN