Provider Demographics
NPI:1780671263
Name:KIDWAI, SHAHAB U (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHAB
Middle Name:U
Last Name:KIDWAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2000 N FEDERAL HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1022
Mailing Address - Country:US
Mailing Address - Phone:954-783-0223
Mailing Address - Fax:954-786-8628
Practice Address - Street 1:2000 N FEDERAL HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1022
Practice Address - Country:US
Practice Address - Phone:954-783-0223
Practice Address - Fax:954-786-8628
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036081174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02244Medicare ID - Type UnspecifiedMEDICARE