Provider Demographics
NPI:1336157494
Name:SHIMAN, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:SHIMAN
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 1:455 NW 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7984
Mailing Address - Country:US
Mailing Address - Phone:954-752-7539
Mailing Address - Fax:954-726-0188
Practice Address - Street 1:7421 N UNIVERSITY DR
Practice Address - Street 2:#203
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2977
Practice Address - Country:US
Practice Address - Phone:954-722-3200
Practice Address - Fax:954-726-0188
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93497Medicare ID - Type Unspecified
FLD66075Medicare UPIN