Individual
MICHAEL SHAMUS MCHALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
40100 HIGHWAY 27, DAVENPORT, FL 33837
(863) 422-4971
Mailing address
8390 CHAMPIONS GATE BOULEVARD, SUITE 306, CHAMPIONS GATE, FL 33896
(407) 390-1677
(407) 390-1765
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS6360
FL
207Q00000X
Family Medicine Physician
OS6360
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
176502578
TRICARE
FL
05
—
375961000
—
FL
01
—
80772B
BCBS
FL
Enumeration date
06/08/2006
Last updated
03/16/2020
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