Provider Demographics
NPI:1922152842
Name:SHALHOUB, HADI A (DO)
Entity Type:Individual
Prefix:
First Name:HADI
Middle Name:A
Last Name:SHALHOUB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3735
Mailing Address - Country:US
Mailing Address - Phone:772-581-8900
Mailing Address - Fax:772-581-4478
Practice Address - Street 1:13110 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3735
Practice Address - Country:US
Practice Address - Phone:772-581-8900
Practice Address - Fax:772-581-4499
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7619208D00000X
FLOS 76192086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8582900Medicaid
FLG53205Medicare UPIN
FL56720YMedicare ID - Type Unspecified