Provider Demographics
NPI:1861437188
Name:SHENKER, CHARLES PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PAUL
Last Name:SHENKER
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 1:21150 BISCAYNE BOULEVARD
Mailing Address - Street 2:STE 208
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-705-0501
Mailing Address - Fax:305-705-0502
Practice Address - Street 1:21150 BISCAYNE BOULEVARD
Practice Address - Street 2:STE 208
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-705-0501
Practice Address - Fax:305-705-0501
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30420207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4192330001Medicare NSC
FL92867Medicare PIN
D60219Medicare UPIN