Organization
GENESISCARE USA OF FLORIDA LLC
Active
Parent organization
GENESISCARE USA INC.
Other names
Thomas J. Shaknovsky, DO
Organization subpart
Yes
Provider details
NPI number
Legal business name
GENESISCARE USA INC.
Authorized official
SHADEN MARZOUK (PRESIDENT)
(239) 931-7254
Entity
Organization
Contact information
Practice address
36468 EMERALD COAST PKWY STE 11103, DESTIN, FL 32541-0741
(850) 660-5204
(850) 660-5206
Mailing address
1419 SE 8TH TER STE 200, CAPE CORAL, FL 33990-3213
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
04/14/2020
Last updated
01/31/2025
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