Provider Demographics
NPI:1780695478
Name:SHAWBITZ, MICHAEL L (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:SHAWBITZ
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 1:1034 MAR WALT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6639
Mailing Address - Country:US
Mailing Address - Phone:850-315-9211
Mailing Address - Fax:850-315-9350
Practice Address - Street 1:1034 MAR WALT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6639
Practice Address - Country:US
Practice Address - Phone:850-315-9211
Practice Address - Fax:850-315-9350
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38803174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE32336Medicare UPIN