Provider Demographics
NPI:1649465378
Name:SHAHLA, ZIAD (MD)
Entity type:Individual
Prefix:
First Name:ZIAD
Middle Name:
Last Name:SHAHLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 TERRENE CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-9900
Mailing Address - Country:US
Mailing Address - Phone:239-948-3444
Mailing Address - Fax:239-948-9028
Practice Address - Street 1:8800 TERRENE CT
Practice Address - Street 2:SUITE 102
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-9900
Practice Address - Country:US
Practice Address - Phone:239-948-3444
Practice Address - Fax:239-948-9028
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0066854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
26304YMedicare Oscar/Certification
K0874Medicare PIN
F92847Medicare UPIN