Provider Demographics
NPI:1144462110
Name:MICHAEL L SHAWBITZ M D P A
Entity type:Organization
Organization Name:MICHAEL L SHAWBITZ M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-315-9211
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:850-863-2153
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:850-863-2153
Practice Address - Fax:850-315-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00388032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065692500Medicaid
FL065692500Medicaid
FLBQ061AMedicare PIN
FL93931YMedicare PIN