Provider Demographics
NPI:1760586044
Name:SHOOK, MICHAEL ROY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROY
Last Name:SHOOK
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 1:8016 MIZNER LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1134
Mailing Address - Country:US
Mailing Address - Phone:800-427-1902
Mailing Address - Fax:561-883-6071
Practice Address - Street 1:375 NW 51 ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-997-8111
Practice Address - Fax:561-995-0109
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03834OtherBLUE SHIELD
FLP00011966OtherRR MEDICARE
FLP00011967OtherRR MEDICARE
FL03834XMedicare ID - Type Unspecified
FL03834OtherBLUE SHIELD
FL03834VMedicare ID - Type Unspecified
FL03834WMedicare ID - Type Unspecified
D50845Medicare UPIN