Provider Demographics
NPI:1528212628
Name:SHAHAB U KIDWAI MD PA
Entity Type:Organization
Organization Name:SHAHAB U KIDWAI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAJMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDWAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-783-0222
Mailing Address - Street 1:2000 NORTH FEDERAL HIGHWAY
Mailing Address - Street 2:203
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062
Mailing Address - Country:US
Mailing Address - Phone:954-783-0222
Mailing Address - Fax:
Practice Address - Street 1:2000 NORTH FEDERAL HIGHWAY
Practice Address - Street 2:203
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062
Practice Address - Country:US
Practice Address - Phone:954-783-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00360812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty