Provider Demographics
NPI:1811391345
Name:SHAIKH INTERNATIONAL MEDICINE, LLC
Entity Type:Organization
Organization Name:SHAIKH INTERNATIONAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:MR
Authorized Official - First Name:LIAQUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-466-1112
Mailing Address - Street 1:2504 ACORN ST, STUITE A
Mailing Address - Street 2:
Mailing Address - City:FT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947
Mailing Address - Country:US
Mailing Address - Phone:772-466-1112
Mailing Address - Fax:772-466-1184
Practice Address - Street 1:2504 ACORN ST, SUITE A
Practice Address - Street 2:
Practice Address - City:FT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947
Practice Address - Country:US
Practice Address - Phone:772-466-1112
Practice Address - Fax:772-466-1184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAIKH INTERNATIONAL MEDICINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253365100Medicaid
FLD86058Medicare UPIN