Provider Demographics
NPI:1548480270
Name:SHAHLA, MICHAEL S (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:SHAHLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SATEAH
Other - Middle Name:
Other - Last Name:SHAHLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10621 AIRPORT PULLING RD N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-7333
Mailing Address - Country:US
Mailing Address - Phone:239-330-9999
Mailing Address - Fax:239-330-1473
Practice Address - Street 1:10621 AIRPORT PULLING RD N
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-1599
Practice Address - Country:US
Practice Address - Phone:239-330-9999
Practice Address - Fax:239-330-1473
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99285207R00000X, 207R00000X
WV24956207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH767ZMedicare PIN
FLAH767ZMedicare PIN
WVWV1757AMedicare PIN