Provider Demographics
NPI:1801844279
Name:SHAWKAT, TAREK A (MD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:A
Last Name:SHAWKAT
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 1:3466 N HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5713
Mailing Address - Country:US
Mailing Address - Phone:321-434-1771
Mailing Address - Fax:321-434-1775
Practice Address - Street 1:1350 HICKORY ST
Practice Address - Street 2:HOLMES REGIONAL MEDICAL CENTER
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-1771
Practice Address - Fax:321-434-1775
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77769208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274983100Medicaid
FLU7833ZMedicare PIN
FL274983100Medicaid