Provider Demographics
NPI:1831121110
Name:SHAIKH, LIAQUDDIN (MD)
Entity Type:Individual
Prefix:MR
First Name:LIAQUDDIN
Middle Name:
Last Name:SHAIKH
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 1:2504 ACORN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4746
Mailing Address - Country:US
Mailing Address - Phone:772-466-1112
Mailing Address - Fax:772-466-1184
Practice Address - Street 1:2504 ACORN ST
Practice Address - Street 2:SUITE A
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4746
Practice Address - Country:US
Practice Address - Phone:772-466-1112
Practice Address - Fax:772-466-1184
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253365100Medicaid
FLD86058Medicare UPIN
FL253365100Medicaid