Provider Demographics
NPI:1730363912
Name:ECKARDT, SHEA MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:SHEA
Middle Name:MICHAEL
Last Name:ECKARDT
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 1:430 MORTON PLANT ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3398
Mailing Address - Country:US
Mailing Address - Phone:727-443-0611
Mailing Address - Fax:727-461-5493
Practice Address - Street 1:430 MORTON PLANT ST
Practice Address - Street 2:SUITE 405
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3398
Practice Address - Country:US
Practice Address - Phone:727-443-0611
Practice Address - Fax:727-461-5493
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-23
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247067-1207R00000X
FLME 106174207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001992800Medicaid
P01024473OtherRR MCARE
FL001992800Medicaid
DJ896YMedicare PIN